Emergent medical and surgical management of mediastinal infantile hemangioma with symptomatic spinal cord compression: case report and literature review.
OBJECTIVE
We report an extremely rare case of a patient with a large, cervical, and upper thoracic cutaneous hemangioma associated with a separate, underlying mediastinal hemangioma extending to the epidural space causing significant spinal cord compression.


METHODS
A 6-week-old female presented with decreased movement of her right arm and bilateral lower extremity hyperreflexia. Her arm weakness progressed to paralysis over the course of 24 h. She underwent emergent surgical decompression and medical therapy with propranolol and systemic corticosteroids.


CONCLUSIONS
While several recent reports have described dramatic responses of hemangiomas to propranolol, this is the first case in which it was used as part of a multimodal approach to symptomatic spinal cord compression. The infant improved immediately after surgery. She is neurologically intact and has radiographic regression of the hemangiomas on follow-up examination 6 months later.
Fulkerson
Daniel H
DH
Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, CCC 1230.01, 12th Floor, Houston, TX 77030, USA. d_fulkers@hotmail.com
Agim
Nnenna G
NG
Al-Shamy
George
G
Metry
Denise W
DW
Izaddoost
Shayan A
SA
Jea
Andrew
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D018324:Hemangioma, Capillary / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology
D000319:Adrenergic beta-Antagonists; D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D006493:Heparin; D011239:Prednisolone; D011433:Propranolol
Ann Surg. 1915 Dec;62(6):641-9
17863459
Pediatr Radiol. 1999 Jul;29(7):517-9
10398787
In Vitro Cell Dev Biol Anim. 2002 May;38(5):298-304
12418927
Arch Dermatol. 2001 Sep;137(9):1208-13
11559219
J Am Acad Dermatol. 2003 Apr;48(4):477-93; quiz 494-6
12664009
AJNR Am J Neuroradiol. 2009 May;30(5):1005-13
19213817
J Neurosurg Spine. 2005 Sep;3(3):249-52
16235712
J Dtsch Dermatol Ges. 2010 Mar;8(3):184-6
19788583
Pediatr Dermatol. 2005 Sep-Oct;22(5):383-406
16190987
Int J Pediatr Otorhinolaryngol. 2009 Dec;73(12):1821-3
19796830
Arch Dermatol. 2002 Dec;138(12):1567-76
12472344
Pediatr Neurol. 2008 Dec;39(6):423-5
19027589
Pediatr Dermatol. 2008 Mar-Apr;25(2):193-5
18429777
Pediatrics. 2009 Sep;124(3):e423-31
19706583
J Eur Acad Dermatol Venereol. 2009 Dec;23(12):1465-6
19453811
Int J Pediatr Otorhinolaryngol. 2009 Aug;73(8):1168-72
19481268
J Pediatr. 1968 Mar;72(3):351-7
5639749
Arch Dermatol. 2004 May;140(5):591-6
15148105
Arch Dermatol. 1977 Nov;113(11):1587-90
931402
Pediatrics. 1989 Jun;83(6):977-80
2657627
Pediatr Dermatol. 2009 Sep-Oct;26(5):610-4
19840322
Hum Pathol. 1995 Apr;26(4):416-21
7705821
Arch Dermatol. 2010 Dec;146(12):1391-6
20713775
Eur J Pediatr Surg. 2002 Dec;12(6):366-74
12548487
Neuropediatrics. 1990 Aug;21(3):160-1
2234322
N Engl J Med. 2008 Jun 12;358(24):2649-51
18550886
J Pediatr. 1997 Oct;131(4):643-6
9386676
Pediatrics. 2006 Sep;118(3):882-7
16950977
Pediatrics. 2009 Nov;124(5):1447-56
19858157
J Pediatr Surg. 1992 Oct;27(10):1291-3
1403505
Pediatr Dermatol. 2008 Mar-Apr;25(2):168-73
18429772
N Engl J Med. 1992 May 28;326(22):1456-63
1489383
Neuroradiology. 1978;16:82-4
740218
J Neurosurg Pediatr. 2009 May;3(5):429-34
19409024
Laryngoscope. 2009 Oct;119(10):2051-4
19650125
N Engl J Med. 2008 Dec 25;359(26):2846; author reply 2846-7
19109584
Am J Med Genet A. 2006 May 1;140(9):975-86
16575892
Plast Reconstr Surg. 1967 Jan;39(1):76-83
6018814
Hum Pathol. 2000 Jan;31(1):11-22
10665907