Surgical treatment of rare localization of aggressive sacral hemangioma (literature review and clinical case)

Introduction. Lesions of the sacrococcygeal spine hemangioma are quite rare (up to 1% of cases of all spinal hemangiomas). Publications devoted to the surgical treatment of patients with this level of localization of aggressive hemangioma do not give a clear idea of the preferred surgical techniques.

Research objective. To analyze and demonstrate the surgical treatment result of a patient with aggressive hemangioma of the S2 vertebra. Material and methods. Balloon kyphoplasty with using left-sided transcutaneous transpedicular access was performed on a 36-year-old patient

Results. The pain syndrome intensity before surgery was 8 points on the visual analog scale (VAS), after surgery 2 points. According to the Oswestry questionnaire (ODI), life limitations were estimated at 16 points before treatment, and 4 points after surgery. VAS and ODI indicators were 0 points a month after surgical treatment. Computed tomography performed on the 1st day after surgery showed complete filling of the defect with a bone composite without its moving outside the vertebral body. Repeated examination 6 and 12 months after surgical treatment revealed no signs of tumor recurrence.

Conclusion. The presented clinical case may be of interest to a wide audience, due to the insufficient information of the issues of surgical treatment of aggressive spinal hemangiomas of rare localization in the sacrum area.

1. Klimov V.S., Kosimshoev M.A., Evsyukov A.V. et al. The results of differentiated surgical treatment of aggressive vertebral hemangiomas. Spine surgery. 2018;15(1): 79-90 (in Russ.).].

2. Zaretskov V.V., Arsenievich V.B., Likhachev S.V. et al. Surgical treatment of aggressive hemangiomas of the transitional cervical-thoracic spine in children (clinical observations, preliminary results). Orthopedics, traumatology and reconstructive surgery of childhood. 2019;7(2): 79-86 (in Russ.).].

3. Kasch R., Scheele J., Hancock M. et al. Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI. PloS One. 2019;14(9):e0219846. doi.org/10.1371/journal.pone.0219846

4. Abul-Kasim K., Persson E., Levinsson A. et al. Vertebral Hemangiomas: Prevalence, New Classification and Natural History. Magnetic Resonance Imaging-Based Retrospective Longitudinal Study. Neuriradiol J. 2023;36(1): 23–30. doi.org/10.1177/19714009221098

5. Zhang L., Wang B., Han S. et al. Imaging features and atypical signs of symptomatic vertebral haemangioma: a retrospective single-centre analysis of 118 patients. Br J Radiol. 2021. 94(1121): 20201250. doi.org/10.1259/bjr.20201250

6. Jiménez-Ávila J.M., Ibarra-Elizalde V.B., González-Cisneros A.C. Cervical vertebral hemangioma with aggressive behavior. Acta Ortop Mex. 2021;35(2): 206–210. doi.org/10.35366/101868.

7. Garmatyna O. Yu. Radiological imaging of vertebral hemangioma. Ukrainian radiological journal. 2014;22 (3): 60-63 (in Russ.).

8. Grushina T. I., Titov A. A. Current view on vertebral hemangioma. N. N. Priorov Journal of Traumatology and Orthopedics. 2020; 27(1): 77–83 (In Russ.). doi.org/10.17816/vto202027177-83

9. Mizyurov S.A., Zaretskov V.V., Likhachev S.V. et al. Radiation diagnosis and therapy for spinal hemangiomas // Bulletin of Radiology and Radiology. 2020;101(3): 183-192. (In Russ.). doi.org/10.20862/0042-4676-2020-101-3-183-192

10. Singh P.K., Verma S.K., Chandra P.S. et al. Management of Myelopathy due to Anterior Soft-Tissue Compression in Vertebral Hemangioma. World Neurosurg. 2021;155: 1–8. doi.org/10.1016/j.wneu.2021.06.059

11. Kravtsov M. N., Manukovskii V. A., Zharinov G. M. et al. Aggressive vertebral hemangiomas: optimization of management tactics. Burdenkos Journal of Neurosurgery. 2012; 76 (2): 23-32 (in Russ.).

12. Kravtsov M. N., Manukovsky V. A., Manashchuk V. I. et al. Diagnosis and treatment of aggressive vertebral hemangiomas //Clinical guidelines. Moscow. 2015: 35. (in Russ.).

13. Canbay S., Kayalar A.E., Sabuncuoğlu G. Gel. H. A novel surgical technique for aggressive vertebral hemangiomas. Neurocirugia (Astur: Engl Ed). 2019. 30(5): 233–237. doi.org/10.1016/j.neucir.2018.08.003

14. Nambiar M., Maingard J.T., Onggo J.R. et al. Retrospective Study Single Level Percutaneous Vertebroplasty for Vertebral Hemangiomata A Review of Outcomes. Pain Physician. 2020. 23(6): 637–642. doi.org/10536/DRO/DU:30148741

15. Zaretskov V. V., Arsenievich V. B., Likhachev S. V. et al. To the question of using balloon kyphoplasty in surgical treatment of aggressive vertebral hemangioma (case report). 2020;26(2): 234-237. (in Russ.). doi.org/10.18019/1028-4427-2020-26-2-234-237

16. Moore J. M., Poonnoose S., McDonald M. Kyphoplasty as a useful technique for complicated hemangiomas. J. Clin. Neurosci. 2012;19(9): 1291–1293. doi.org/10.1016/j.jocn.2011.12.012

17. Deep N. et al. Large Intraosseous Haemangioma of the Sacral Vertebra: The radiological imaging findings. Sultan Qaboos University Medical Journal. 2023;23(1): 125-126. doi.org/10.18295/squmj.3.2022.024

18. Pokhrel A. et al. A Rare Case of Epithelioid Hemangioma Presenting as an Isolated Sacral Mass. Cureus. 2022;14(10): e29801. doi.org/10.7759/cureus.29801

19. Wang G. X. et al. Recurrence of an aggressive sacral hemangioma with atypical radiological features after surgical resection: A case report and literature review. 2022: 1-8. doi.org/10.21203/rs.3.rs-1374878/v1

20. Chen Y. L., Yang S. H., Kuo S. H. Radiotherapy efficacies for vertebral hemangioma patients with severe spinal cord compression and cauda equina syndrome. 2021: 1-10. doi.org/10.21203/rs.3.rs-292408/v1

21. Luz L. X. D. A. et al. Aggressive vertebral hemangiomas–case series and literature review //Coluna/Columna. 2020. 19: 293-296. doi.org/10.1590/S1808-185120201904223670

22. Qiu B. et al. Surgical management of aggressive hemangiomas of the spine. Journal of Clinical Neuroscience. 2020;78: 67-72. doi.org/10.1016/j.jocn.2020.06.012

23. Chen Y. et al. Surgical treatment of compressive spinal hemangioma: A case series of three patients and literature review. Der Orthopade. 2018;47(3): 221-227. doi.org/10.1007/s00132-017-3503-6

24. Kaoudi A. et al. Robot-assisted radiofrequency ablation of a sacral S1-S2 aggressive hemangioma //World Neurosurgery. 2018;116: 226-229. doi.org/10.1016/j.wneu.2018.05.060

25. Likhachev S. V. et al. Decompression-stabilizing operations in the treatment of complicated aggressive hemangiomas of the transitional spine. Saratov Journal of Medical Science. 2017;13(3): 746-751 (in Russ.).

26. Cloran F. J. et al. Aggressive spinal haemangiomas: imaging correlates to clinical presentation with analysis of treatment algorithm and clinical outcomes. The British journal of radiology. 2015;88(1055): 20140771. doi.org/10.1259/bjr.20140771

27. Agarwal V. et al. Sacroplasty for Symptomatic Sacral Hemangioma: A Novel Treatment Approach: A Case Report. Interventional Neuroradiology. 2013;19(2): 245-249. doi.org/10.1177/159101991301900216

28. Atalay B. et al. Sacral kyphoplasty for relieving pain caused by sacral hemangioma .Spinal Cord. 2006;44(3): 196-199. doi.org/10.1038/sj.sc.3101829