AGGRESSIVE VERTEBRAL HEMANGIOMAS – CASE SERIES AND LITERATURE REVIEW

ABSTRACT Objectives To present a series of aggressive hemangiomas of the institution, with a review of the management options described in the literature. Methods This is a retrospective survey of aggressive vertebral hemangiomas treated by the service in the last 10 years, with histological confirmation of the diagnosis and a minimum follow-up of 1 year. The case analysis and literature review were conducted with emphasis on treatment options for these injuries. Results Seven cases were found, three with pain and four with severe neurological deficits. Two patients were treated with open decompression, one with open decompression and cementation, one with open decompression and arthrodesis, one with biopsy and cementation, one with percutaneous biopsy, and one with open biopsy followed by decompression surgery. All patients underwent radiotherapy. There was a significant regression of presentation deficits, but one patient developed an irreversible deficit during treatment. There were no recurrences or late complications in the follow-up period. Conclusions Surgical decompression in patients with significant neurological deficit is a point of consensus in the literature. Subtotal resection followed by radiation therapy was effective in treating deficits and controlling pathology. Cases manifesting pain only can be managed with minimally invasive techniques, whether or not they are followed by radiotherapy. Level of evidence IV; Therapeutic study of case series.

摘要
研究目的：介绍本机构收治的一组侵袭性脊柱血管瘤病例，并复习文献中记载的各类治疗选择。
研究方法：本研究为回顾性调查，对象为近10年由本科室收治的经组织病理学确诊、且随访时长至少1年的侵袭性脊柱血管瘤病例；本次病例分析与文献复习重点聚焦此类病变的治疗方案选择。
研究结果：共纳入7例病例，其中3例以疼痛为主要临床表现，4例存在严重神经功能缺损。治疗方案如下：2例患者接受开放性减压术，1例接受开放性减压联合骨水泥成形术，1例接受开放性减压联合关节融合术，1例接受活检联合骨水泥成形术，1例接受经皮穿刺活检术，1例先行开放性活检，随后行减压手术。所有患者均接受了放射治疗。随访期间，患者的初始神经功能缺损均得到显著改善，但有1例患者在治疗过程中出现了不可逆的神经功能缺损。随访期内未出现病变复发或晚期并发症。
结论：对于存在显著神经功能缺损的患者，手术减压是学界达成共识的治疗方案。次全切除联合放射治疗可有效改善神经功能缺损并控制病变进展。仅表现为疼痛的病例，可采用微创技术治疗，术后可辅以放射治疗。
证据级别：IV级；病例系列治疗性研究。