title: Novel use of propranolol for management of pain in children with vertebral hemangioma: report of two cases.
abstract: BACKGROUND
  Vertebral hemangioma (VH) is an exceedingly rare neoplasm in pediatric population with less than 10 cases reported in the literature. It is usually asymptomatic in adults and diagnosed incidentally at radiographic investigations of other medical conditions. In this report, we describe two children who presented to our institution with severe back pain and were diagnosed with VH.
  
  
  METHODS
  Case 1 was an 8-year-old male with a pain score of 10 out of 10 at presentation. Clinical investigations eliminated the possibility of a neoplasm or infectious process and MRI findings were highly suggestive of an aggressive vertebral hemangioma. Case 2 was a 17-year-old female who presented with back pain radiating to shoulders. Her pain score was 4 out of 10 and she was diagnosed with vertebral hemangioma due to the specific findings on MRI studies.
  
  
  CONCLUSIONS
  Both patients received propranolol with a dose of 20 and 40 mg per day, respectively. They were free of pain at 2 months follow-up. There are different invasive treatment modalities for the management of VH, including vertebroplasty, kyphoplasty, radiotherapy, alcohol injection, embolization, and surgery. These methods have been used in adult patients for several years, but each of them has potential risks which make these options unsuitable for children.
  
  
  CONCLUSIONS
  Propranolol is a beta blocker which is safely used in the management of infantile hemangiomas. This is the first report demonstrating its efficacy in symptomatic treatment of childhood VH. The lesions did not show any regression, but the pain relief obtained was very significant under propranolol therapy.
authors.affiliation: Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
authors.forename: Didem
authors.initials: D
authors.lastname: Uzunaslan
authors.forename: Caner
authors.initials: C
authors.lastname: Saygin
authors.forename: Semih
authors.initials: S
authors.lastname: Gungor
authors.forename: Zehra
authors.initials: Z
authors.lastname: Hasiloglu
authors.forename: Nihal
authors.initials: N
authors.lastname: Ozdemir
authors.forename: Tiraje
authors.initials: T
authors.lastname: Celkan
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D001416:Back Pain / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011433:Propranolol / Q000008:administration & dosage / Q000494:pharmacology*; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013904:Thoracic Vertebrae / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol