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Title: Combined embolotherapy and percutaneous image guided alcohol ablation for aggressive vertebral hemangioma: Preliminary experience in two patients
e-poster Number: EPOS 42
Category: e Poster
Author Name: Dr. Akanksha Nag
Institute:
Co-Author Name:
Abstract :
Introduction:
Treatment for aggressive hemangioma is multidisciplinary including surgery, embolization, percutaneous ablation and radiotherapy, each having its own limitations. Surgery is useful if lesion is causing acute significant neurological deficit. Angio-embolization and percutaneous alcohol ablation are minimally invasive methods for treatment while radiotherapy is mainly useful for painful lesions. Here we are discussing two cases in whom combined percutaneous alcohol ablation and endovascular embolization were performed.
Methods:
2 patients presented with insidious onset B/L lower limb weakness without any history of trauma. CE-MRI showed aggressive hemangioma in dorsal vertebrae (D3 and D7 respectively), including posterior elements with paravertebral and epidural soft tissue component causing spinal cord compression. They were managed initially with trans-arterial embolization using PVA particles with partial clinical improvement. However, residual extra-osseous soft tissue component and spinal cord compression was present, hence percutaneous transpedicular intralesional absolute alcohol injection was done.
Under GA, CT guided percutaneous access of involved vertebral bodies through transpedicular approach was performed. After achieving proper position, 5 ml iodinated diluted contrast was injected which showed enhancement of epidural and paravertebral soft tissue. Absolute alcohol (around 8-10 ml) was slowly injected through needle under constant hemodynamic monitoring.
Results:
Both the patients showed clinical as well as radiological response in immediate postoperative period. However, on long term follow-up (1 year), one of them developed mild recurrent symptoms for which second sitting of embolization and ablation was performed. Currently, both the patients have no significant symptoms on follow-up.
Conclusion:
Combining trans-arterial angio-embolization with percutaneous intralesional alcohol ablation can provide long-term results comparable to surgery or single modality embolization.
