Long-term outcome of percutaneous alcohol embolization combined with percutaneous vertebroplasty in aggressive vertebral hemangiomas with epidural extension

Eur Radiol. 2017 Jul;27(7):2860-2867. doi: 10.1007/s00330-016-4664-0. Epub 2016 Dec 5.

Abstract

Objectives: To evaluate, on a long-term basis, the safety and effectiveness of percutaneous alcohol embolization (PAE) combined with percutaneous vertebroplasty (PVP) as a sole treatment for aggressive vertebral haemangiomas (AVHs) with epidural extension.

Methods: From 1996 to 2015, 26 consecutive patients (15 women [58%] and 11 men; mean age 51.8 years [range: 19-75 years]) underwent PAE combined with PVP (performed at day 15) for the treatment of 27 AVHs with epidural extension. Clinical outcome was evaluated with a mean delay of 88.3 ± 53.3 months (range: 22-217 months). The primary endpoint was pain relief evaluated with a visual analogue scale (VAS).

Results: Pre-procedure mean VAS score was 7.23 ± 1.3 and significantly improved at last follow-up (m = 3.11 ± 1.9; p < 0.001). Ten patients (38.5%) remained asymptomatic. Eighty-eight percent of the patients with neurosensory disorders had complete regression of these symptoms. Two of the three patients with motor deficit did not show any improvement. No major complication was recorded.

Conclusions: PAE combined with PVP is a minimally invasive safe and effective therapeutic approach for AVH with epidural involvement, even on long-term clinical outcome. This technique appears mainly effective for pain and neurosensory symptoms, but seems less effective for motor deficit relief.

Key points: • Combination of PAE with PVP is a safe technique. • PAE combined with PVP is an effective treatment for sensory symptoms. • This strategy seems less effective in patients with motor deficits.

Keywords: Alcohol embolization; Cementoplasty; Intraosseous haemangioma; Percutaneous; Vertebral.

MeSH terms

  • Adult
  • Aged
  • Angiography, Digital Subtraction / methods
  • Chemoembolization, Therapeutic / methods*
  • Combined Modality Therapy
  • Embolization, Therapeutic / methods*
  • Epidural Neoplasms / complications
  • Epidural Neoplasms / diagnosis
  • Epidural Neoplasms / therapy*
  • Ethanol / administration & dosage
  • Female
  • Follow-Up Studies
  • Hemangioma / complications
  • Hemangioma / diagnosis
  • Hemangioma / therapy*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Pain / etiology
  • Pain Management / methods
  • Pain Measurement
  • Retrospective Studies
  • Spinal Neoplasms / complications
  • Spinal Neoplasms / diagnosis
  • Spinal Neoplasms / therapy*
  • Thoracic Vertebrae*
  • Time Factors
  • Treatment Outcome
  • Vertebroplasty / methods*
  • Young Adult

Substances

  • Ethanol