Effective and Successful Control of Symptomatic Vertebral Hemangiomas with Epidural Extension Using Stereotactic Spine Radiosurgery
Vertebral hemangiomas are the most common primary tumors of the spine. Most vertebral hemangiomas are asymptomatic benign lesions, but in a few cases, if the mass grows and extends into the epidural space, compressing the spinal cord or nerve roots, it may lead to neurological symptoms such as pain, sensory abnormalities, or motor deficits. The treatment of symptomatic vertebral hemangiomas with epidural extension (SVHEE) is challenging and often requires a combination of surgical decompression, vascular embolization, percutaneous vertebroplasty, and radiation therapy.
Author Introduction: This study was conducted by a multidisciplinary team from the Cleveland Clinic, including physicians from the departments of neurosurgery, radiation oncology, and the spine health center. The article was published in a neurosurgical journal.
Research Methods: This is a retrospective study that included 14 SVHEE patients who received stereotactic spine radiosurgery (SSRS) treatment at the center between 2007 and 2022. By evaluating the patients’ baseline data, clinical presentations, lesion volumes, Bilsky grading (assessing the degree of epidural compression), and other information, the clinical and imaging changes before and after SSRS treatment were analyzed.
Research Process: a) Treatment details: - 9 patients underwent surgical decompression before SSRS, of which 8 improved neurological symptoms, and 1 remained stable. The average intraoperative blood loss was 400 ml. SSRS was performed at a median time of 2.8 months after surgery. - A single dose of 16-18 Gy was delivered during SSRS. All patients experienced varying degrees of lesion volume reduction after SSRS. - The Bilsky grading system was used to evaluate the degree of epidural compression, and most patients showed a reduction in compression after treatment.
b) Main results: - The median preoperative lesion volume was 36.9 cc, the median volume at the first follow-up after SSRS was 31.5 cc, and the median volume at the final follow-up was 25.15 cc, with all cases showing varying degrees of volume reduction. - 11⁄14 patients experienced clinical symptom improvement, including 8 with spinal cord symptoms and 3 with nerve root symptoms that did not improve (all were lesions remote from the spinal cord).
c) Study conclusions: Single-fraction SSRS is a potentially safe and effective treatment for SVHEE, either alone or in combination with surgical decompression, achieving desirable lesion control. However, larger sample sizes and longer follow-up prospective studies are still needed to further evaluate its efficacy and risk of complications.
d) Research highlights: - The largest single-center study to date reporting SSRS treatment for SVHEE patients. - The first study to use the Bilsky grading system to evaluate the efficacy of SVHEE treatment and found that SSRS can alleviate epidural compression symptoms. - The first report of 5 cases achieving desirable outcomes with SSRS as a single treatment modality.
e) Other noteworthy information: One patient experienced an asymptomatic vertebral compression fracture 2 years after SSRS treatment, which did not require special intervention. Overall, SSRS is a treatment option with a relatively low risk of complications.
This study provides a new non-surgical treatment option for the rare condition of SVHEE and lays the foundation for further optimizing individualized treatment strategies.