Radiotherapy in the treatment of symptomatic vertebral hemangiomas: Technical case report

OBJECTIVE AND IMPORTANCE: In contrast to the frequent finding of vertebral hemangiomas at autopsy and during radiographical examinations, symptomatic lesions are rare. In the literature, a variety of therapies and combinations of therapies have been reported. There is, however, significant inconsistency regarding which therapy is considered appropriate. CLINICAL PRESENTATION: We report a young man with multiple vertebral hemangiomas, epidural extension, and secondary spastic paraparesis. INTERVENTION: Rapid neurological deterioration and the clinical suspicion of malignant disease led to an initial decompressive laminectomy and biopsy of the intraspinal soft tissue lesion. Postoperative radiotherapy produced, however, substantial effects, with complete regression of the epidural hemangioma. CONCLUSION: Based on the literature, we focus on diagnostic problems and choice of therapy for vertebral hemangiomas. Further, we discuss in particular the beneficial role of radiotherapy in the treatment of these nonmalignant lesions.