title: Treatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study.
abstract: BACKGROUND
  Vertebral hemangiomas (VH) are the most common lesions of the vertebral column.
  
  
  OBJECTIVE
  To evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in VH presenting with myelopathy.
  
  
  METHODS
  This is was a prospective study of single-level symptomatic VH with cord compression. Exclusions were as follows: pathological fractures, deformity, or multilevel pathologies. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-segment instrumented fusion using pedicle screws.
  
  
  RESULTS
  Ten patients (mean, 26.8 ± 18.11; range, 10-68 years; 8 females) were treated with use of this technique. Clinical features included myelopathy with motor and sensory involvement in all (4 paraplegic), sphincter involvement (8), and severe local pain (5). The preoperative American Spinal Injury Association (ASIA) scores were A (3), B (1), and C (6). All had pan vertebral body VH with severe cord compression. The mean surgical time was 102 ± 22 minutes; average blood, 296 ± 90.82 mL. Mean amount of absolute alcohol injected was 12.6 ± 4.7 mL (1 requiring 25 mL). Immediate embolization was achieved in all patients allowing laminectomy and soft-tissue hemangioma removal. Postsurgery, all patients showed improvement (sphincters improved in 4) at a follow-up ranging 12 to 26 months (transient neurological deterioration in 1). Postsurgery ASIA scores were D (5) and E (5) at last follow-up. Two patients showed evidence of bone sclerosis on follow-up CT scans at 1.2 and 1.5 years.
  
  
  CONCLUSIONS
  This procedure seems to be a safe, efficient method to treat VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, and rigid fusion at the same sitting.
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Singh
authors.forename: Nalin K
authors.initials: NK
authors.lastname: Mishra
authors.forename: Hari Har
authors.initials: HH
authors.lastname: Dash
authors.forename: Rajender K
authors.initials: RK
authors.lastname: Thyalling
authors.forename: Bhawani S
authors.initials: BS
authors.lastname: Sharma
authors.forename: Chitra
authors.initials: C
authors.lastname: Sarkar
authors.forename: P Sarat
authors.initials: PS
authors.lastname: Chandra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D019299:Decompression, Surgical / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006391:Hemangioma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000601:surgery*; D055815:Young Adult
chemical_list: D000431:Ethanol