Surgical tactics for the treatment of aggressive spinal hemangiomas

Hemangiomas of the spine are a problem that often does not require surgical intervention. This pathology occurs in every tenth person, especially among older women. Hemangiomas are most often localized in the thoracic and lumbar spine and are asymptomatic. Goal. To present several cases of successful surgical treatment of aggressive spinal hemangiomas using various methods generally accepted in the neurosurgical community. Materials and methods. In 2022 Nine patients with spinal hemangiomas underwent surgical treatment at the Alexander-Mariinsky Regional Clinical Hospital in Astrakhan. Six of them underwent puncture vertebroplasty under radiation control, and three underwent open spinal cord decompression and microsurgical removal of the neoplasm. This paper presents two clinical cases demonstrating different tactics of surgical treatment. Results. Surgical treatment of 9 patients with aggressive spinal hemangiomas demonstrated the effectiveness of various tactics, including minimally invasive puncture vertebroplasty and open decompression interventions. The application of an individualized approach helped to preserve the quality of life of patients and prevent the increase of neurological deficits. Conclusion. In conclusion, based on clinical experience and analysis of generally accepted techniques, optimal approaches to the treatment of aggressive vertebral hemangiomas with neurological manifestations can be identified. Bone cement vertebroplasty has proven to be a highly effective and minimally invasive method that eliminates the need for radiation therapy if successfully performed. This method remains the most preferred in the regions of the Russian Federation. At the same time, laminectomy and microsurgical removal of the intracanal part of the tumor are associated with a high risk of intraoperative blood loss. Nevertheless, it was possible to minimize surgical trauma even in the presence of a profusely vascularized component of the neoplasm, which allows achieving satisfactory clinical results.

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