eMedicine Specialties > Radiology > Musculoskeletal

Hemangioma, Bone: Follow-up

Author: Ishmael Chasi, MB, ChB, FRCR, Consultant Radiologist, Department of Radiology, University Hospital of North Durham, UK
Coauthor(s): Geoff Hide, MBBS, MRCP, FRCR, Consultant Musculoskeletal Radiologist, Department of Radiology, Freeman Hospital; Honorary Clinical Lecturer, Faculty of Medical Sciences, University of Newcastle upon Tyne
Contributor Information and Disclosures

Updated: Jun 24, 2009

Intervention

Hemangiomas should be treated only if symptomatic; treatment options depend on the site of the lesion, the severity of the symptoms, and the medical expertise available. Medical treatment and clinical observation can be used as first-line management, especially in patients with mild-to-moderate symptoms. Other treatment options are available when this does not suffice or when clinically appropriate.14,15

Treatment modalities

Embolization

Embolization of hemangiomas is performed prior to surgery; it helps reduce the vascularity of the lesions and, therefore, intraoperative blood loss. Embolization may also relieve cord compression by reducing lesion bulk.

Surgery

Surgery usually is reserved for refractory cases and for cases complicated by vertebral collapse with neural compression. Ideally, it is preceded by lesion embolization, and may be combined with postoperative radiation therapy, especially when pain occurs with neurologic compression. The surgical options may entail lesion excision, decompressive laminectomy, resection of epidural extension, bone grafting, and use of metallic prostheses.

Percutaneous vertebroplasty

Percutaneous vertebroplasty was introduced in France in 1984. It was first used for the treatment of vertebral hemangiomas and, subsequently, osteoporotic and malignant vertebral collapse. Vertebroplasty is minimally invasive and provides stabilization of the vertebral body and prompt, lasting pain relief that allows for early mobilization of the patients.

Vertebroplasty is ideal in the absence of cord compression or posterior arch and/or pedicle involvement, but it has also been used prior to surgical decompression to consolidate the vertebral body and reduce hemorrhagic complications.16,17 Vertebroplasty may be used in combination with embolization or ethanol injection.18

Direct ethanol injection

CT-guided direct injection of ethanol as a sclerosing agent has been used to treat vertebral hemangiomas complicated by cord and nerve root compression. This method has been shown to be effective and safe, providing symptomatic relief and lesion obliteration.

Treatment by lesion

Vertebral lesions

Controversial approaches to the management of these lesions are reflected by the range of treatment options available. Options include radiation therapy, embolization, surgical resection, vertebroplasty, and intralesional injection of a sclerosant. These approaches can be used alone or in combination.

Radiation therapy is the most common treatment modality and an effective tool in the management of these lesions. It is used either as primary treatment for alleviating pain (probably as a result of its anti-inflammatory properties), for facilitating reossification, or for postsurgical care to prevent recurrence and relapse of symptoms. Obliteration of the lesion can occur with radiotherapy, but this effect is not prompt enough for treatment of cord compression.

Calvarial lesions

Curative marginal resection of these lesions can be achieved without local recurrence.

Long-bone lesions

Excision of the lesions and bone grafting are the mainstays of treatment of disease in the extremities.

Special Concerns

  • Expansion and collapse of previously asymptomatic spine hemangiomas has been known to occur in pregnancy.
 


More on Hemangioma, Bone

Overview: Hemangioma, Bone
Imaging: Hemangioma, Bone
Follow-up: Hemangioma, Bone
Multimedia: Hemangioma, Bone
References
Further Reading
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References

  1. Dahnert W. Haemangioma, bone. In: Radiology Review Manual. 4th ed. 1999: 76-7.

  2. Resnik D, Kyriakos M, Greenway GD. Tumors and tumor-like lesions of bone. 4th ed. Diagnosis of Bone and Joint Disorders;. 2002:3979-85.

  3. Devaney K, Vinh TN, Sweet DE. Surface-based hemangiomas of bone: a review of 11 cases. Clin Orthop. Mar 1994;233-40. [Medline].

  4. Calianeller T, Ozdemir O, Yildirim E, Kiyici H, Altinörs N. Cavernous hemangioma of temporalis muscle: report of a case and review of the literature. Turk Neurosurg. 2007;17(1):33-6. Review. [Medline].

  5. Magliulo G, Parrotto D, Sardella B, Della Rocca C, Re M. Cavernous hemangioma of the tympanic membrane and external ear canal. Am J Otolaryngol. May-Jun 2007;28(3):180-3. Review. [Medline].

  6. Naama O, Gazzaz M, Akhaddar A, Belhachmi A, Asri A, Elmostarchid B, et al. Cavernous hemangioma of the skull: 3 case reports. Surg Neurol. Jan 18 2008;[Epub ahead of print]:[Medline].

  7. Madge SN, Simon S, Abidin Z, Ghabrial R, Davis G, McNab A, et al. Primary orbital intraosseous hemangioma. Ophthal Plast Reconstr Surg. Jan-Feb 2009;25(1):37-41. [Medline].

  8. Nielsen GP, Srivastava A, Kattapuram S, Deshpande V, O'Connell JX, Mangham CD, et al. Epithelioid hemangioma of bone revisited: a study of 50 cases. Am J Surg Pathol. Feb 2009;33(2):270-7. [Medline].

  9. Khanam H, Lipper MH, Wolf CL, Lopes MB. Calvarial haemangiomas: report of two cases and review of the literature. Surg Neurol. 2001;55(1):63-67. [Medline].

  10. Choi JJ, Murphey MD. Angiomatous skeletal lesions. Semin Musculoskeletal Radiology. 2000;4(1):103-12. [Medline].

  11. Ross JS, Masaryk TJ, Modic MT, et al. Vertebral haemangiomas: MR imaging. Radiology. 1987;165(1):165-9.

  12. Han BK, Ryu JS, Moon DH, et al. Bone SPECT imaging of vertebral haemangioma correlation with MR imaging and symptoms. Clin Nucl Med. 1995;20(10):916-21.

  13. Kahana A, Lucarelli MJ, Grayev AM, Van Buren JJ, Burkat CN, Gentry LR. Noninvasive dynamic magnetic resonance angiography with Time-Resolved Imaging of Contrast KineticS (TRICKS) in the evaluation of orbital vascular lesions. Arch Ophthalmol. Dec 2007;125(12):1635-42. [Medline].

  14. Acosta FL Jr, Sanai N, Chi JH, Dowd CF, Chin C, Tihan T, et al. Comprehensive management of symptomatic and aggressive vertebral hemangiomas. Review. Neurosurg Clin N Am. Jan; 2008;19(1):17-29. [Medline].

  15. Bandiera S, Gasbarrini A, De lure F, et al. Symptomatic vertebral hemangioma; the treatment of 23 cases and a review of the literature. Chir Organi Mov. 2002;87(1):1-15. [Medline].

  16. Cortet B, Cotten A, Deprex X, et al. Value of vertebroplasty combined with surgical decompression in the treatment of aggressive spinal angioma. Apropos of 3 cases. Revue du Rhumatisme. Edition Francaise. 1994;61:16-22.

  17. Ide C, Gangi A, Rimmelin A, et al. Vertebral Haemangiomas with spinal cord compression: the place of preoperative percutaneous vertebroplasty with methyl methacrylate. Neuroradiology. 1996;38(6):585-9.

  18. Feydy A, Cognard C, Miaux Y, et al. Acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas: report of 2 cases. Neuroradiology. 1996;38:389-91.

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Keywords

bone hemangioma, hemangioma, hemangioma of bone, osseous hemangioma, cavernous hemangioma, capillary hemangioma

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Contributor Information and Disclosures

Author

Ishmael Chasi, MB, ChB, FRCR, Consultant Radiologist, Department of Radiology, University Hospital of North Durham, UK
Ishmael Chasi, MB, ChB, FRCR is a member of the following medical societies: Royal College of Radiologists
Disclosure: Nothing to disclose.

Coauthor(s)

Geoff Hide, MBBS, MRCP, FRCR, Consultant Musculoskeletal Radiologist, Department of Radiology, Freeman Hospital; Honorary Clinical Lecturer, Faculty of Medical Sciences, University of Newcastle upon Tyne
Geoff Hide, MBBS, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Michael A Bruno, MD, Associate Professor, Departments of Radiology and Medicine, Pennsylvania State University College of Medicine; Director, Radiology Quality Management Services, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Michael A Bruno, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, Society of Nuclear Medicine, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Theodore E Keats, MD, Professor, Departments of Radiology and Orthopedics, University of Virginia School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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