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Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient

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Abstract

Purpose

Vertebral hemangiomas are benign, highly vascular spinal lesions that are extremely rare in the pediatric population. We report a pediatric case of symptomatic vertebral hemangioma treated with total en bloc spondylectomy. Our objective is to demonstrate that en bloc spondylectomy is feasible and addresses some pitfalls of traditional total tumor resection.

Methods

Our patient presented with bilateral lower limb and perineal paresthesia, paraparesis, as well as urinary retention. Locally aggressive vertebral hemangioma was the presumed diagnosis following imaging. The patient received partial angioembolization to reduce the vascularization of the lesion then underwent total en bloc spondylectomy of T8 under intraoperative neuromonitoring. The intervention was well tolerated.

Results

Postoperative course was marked by clinical improvement and only transient, treatable complications. On 1-year follow-up, the patient is neurologically intact, and imaging reveals adequate position of hardware, good alignment, and no tumor recurrence.

Conclusion

Total en bloc spondylectomy is a feasible procedure in pediatric patients. It reduces local recurrence through reduction of tumor cell contamination and residual tumor and thus may avoid postoperative radiotherapy in select cases. It may also enhance functional neurological recovery by allowing circumferential decompression and increased spinal cord blood flow.

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada

    Tristan Brunette-Clément & Alexander G. Weil

  2. Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada

    Daniel Shedid

Authors
  1. Tristan Brunette-Clément
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  2. Alexander G. Weil
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  3. Daniel Shedid
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Corresponding author

Correspondence to Alexander G. Weil.

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All the authors involved in the production of this manuscript have no conflict of interest to report.

Ethical approval

IRB/ethics committee approval and patient consent were neither required nor sought. A single case was used to illustrate and discuss an operative nuance. No identificatory information was included.

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Brunette-Clément, T., Weil, A.G. & Shedid, D. Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient. Childs Nerv Syst 37, 2115–2120 (2021). https://doi.org/10.1007/s00381-020-04954-3

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  • DOI: https://doi.org/10.1007/s00381-020-04954-3

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