A less aggressive approach to the treatment of aggressive vertebral hemangioma of the thoracic spine: A case report and literature review.

BACKGROUND: Different treatments are available for aggressive vertebral hemangioma [AVH], but a consensus is yet to be reached about the best therapeutic approach. PURPOSE: To explore the possibility that selecting a less aggressive therapeutic approach for AVH decreases the intraoperative and postoperative complications while providing similar clinical, radiographic, and disease-free survival results to more aggressive therapeutic methods. STUDY: We report the case of an AVH of the thoracic spine at the T5 level, treated via perioperative selective arterial embolization plus surgical decompression via laminectomy and reconstruction with polymethylmethacrylate (PMMA) vertebroplasty. PATIENT: The patient was a 17-year-old male referred to our center with the chief complaint of low back pain from two months earlier, without any response to analgesics, and with neurologic manifestations as paraparesis (one month) and progressive sphincter problems (one week). Upon imaging, the impression was an aggressive spinal tumor with cord compression. OUTCOME MEASURES: After the operation, the patient's pain immediately improved, and his neurologic manifestations progressively improved. RESULTS: The patient started walking with help about three weeks after the operation. Roughly six months later, he achieved a complete neurological recovery. At present, about two years following the operation, he has a normal life without any neurological problems. CONCLUSION: Based on our experience with AVH, the selection of less aggressive therapeutic approaches such as perioperative diagnostic angiography and selective embolization decrease the intraoperative and postoperative complications like intraoperative bleeding and neurological injury, while achieving similar clinical, radiographic, and disease-free survival outcomes to more aggressive therapeutic methods.