title: Pregnancy related symptomatic vertebral hemangioma.
abstract: Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.
authors.affiliation: Department of Neurology, GB Pant Hospital, New Delhi, India.
authors.forename: Meena
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Neurology, GB Pant Hospital, New Delhi, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Nayak
authors.affiliation: Department of Neurosurgery, GB Pant Hospital, New Delhi, India.
authors.forename: Hukum
authors.initials: H
authors.lastname: Singh
authors.affiliation: Department of Neurology, GB Pant Hospital, New Delhi, India.
authors.forename: Geeta
authors.initials: G
authors.lastname: Khwaja
authors.affiliation: Department of Neurology, GB Pant Hospital, New Delhi, India.
authors.forename: Debashish
authors.initials: D
authors.lastname: Chowdhury
keywords: Epidural extension; laminectomy; pregnancy; spinal cord compression; vertebral hemangioma
references.citation: J Neurol Neurosurg Psychiatry. 1986 Jun;49(6):709-12
references.pmid: 3734828
references.citation: N Engl J Med. 1958 Apr 3;258(14):685-7
references.pmid: 13526922
references.citation: J Neurosurg. 1993 Jan;78(1):36-45
references.pmid: 8416240
references.citation: Eur Spine J. 2008 Sep;17 Suppl 2:S299-303
references.pmid: 18224354
references.citation: Neurosurg Focus. 2005 Sep 15;19(3):E7
references.pmid: 16190606