Long-term outcomes of excision surgery for aggressive vertebral hemangiomas.

PURPOSE: To describe the clinical outcomes in patients with aggressive vertebral hemangiomas (AVHs) after total tumor excision and discuss the treatment options for AVHs.

METHODS: A retrospective data review of 15 patients (6 men, 9 women) with AVHs who underwent total excision between 1996 and 2018 was performed.

RESULTS: In total, 13 thoracic and 2 lumbar lesions were involved with 8 type A-D tumors and 7 type B-D tumors based on Weinstein-Boriani-Biagini classification. All tumors showed low or low-iso signal intensity (SI) by T1-weighted MRI. All patients received a combination of preoperative transarterial embolization and total tumor excision including the tumor margins. Eleven patients underwent total tumor excision as the initial surgery (total en bloc spondylectomy = 10 patients, piecemeal total tumor excision = 1 patient) and 4 underwent it either as a revision procedure 2-weeks after ineffective laminectomy or in the long-term follow-up (4-14 years) as a piecemeal total tumor excision. Intraoperative blood loss ranged from 150 to 3400 mL (mean, 1314 mL). None of the cases had a recurrence during the mean follow-up period of 128.4 ± 88.6 months.

CONCLUSION: Low SI on T1-weighted MRI was observed in all the patients with AVHs. The long-term clinical results of the preoperative transarterial embolization and total tumor excision were satisfactory. The effect of decompressive incomplete tumor excision is temporary for AVHs and repeated tumor excision may be necessary because of tumor recurrence in the long-term. Reliable total tumor excision during the initial surgery is desirable.