PMC5496113_01
CT: fracture of both pedicles, left transverse process, and anterior and middle column of L1. There is absolutely no hemangioma or any other spinal soft tissue lesions at the left pedicle, left transverse process, and lamina.
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This examination revealed absolutely no hemangioma or any other spinal soft tissue lesions (Figure 1).
(a) CT: enhancing mass that has destroyed the left half of the body, left pedicle, and left transverse process of the L1 vertebra. (b) CT: bone window, partial destruction of the L1 body, absence of the left pedicle, and left transverse process. (c) MRI, axial T1WI, with gadolinium: mass of L1 vertebra destroying the body and compressing the paraspinal soft tissue. (d) MRI, sagittal T2WI: the hemangioma invading the spinal canal.
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MRI and CT scans showed an enhancing tumoral mass that had destroyed one-third of the left L1 vertebra and had expanded to the dural sac, the left L1 root, and the paravertebral muscles (Figures 2(a), 2(b), 2(c), and 2(d)).
Embolization of the left L1 feeder.
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Surgical resection was planned and preoperative embolization which had to be suboptimal due to technical difficulties was performed (Figure 3).
(a) (HE x10) Vascular formations between osseous and collagenous structures, angiomatosis, and papillary endothelial hyperplasia. (b) (HE x10) Angiomatosis with vessels of various sizes involving muscle, fat, and bone tissue. A lesion consisted of a collection of large venous and capillary sized vessels scattered haphazardly throughout the soft tissue, striated muscle, and spongious bone. There are also thrombi in formation in some vessels showing papillary endothelial hyperplasia.
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The histopathological examination revealed vascular formations between osseous and collagenous structures, angiomatosis, and papillary endothelial hyperplasia conclusive of a capillary hemangioma (Figures 4(a) and 4(b)).
(a) CT: the destruction of the L1 vertebra, compared to Figure 2(b), has obviously become more important. (b) MRI, sagittal T2WI: the kyphotic deformity is evidently more prominent. (c) MRI, axial T1WI, with gadolinium: the dimensions of the hemangioma have clearly increased; the destruction of the L1 vertebra has obviously become more important.
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At one-year follow-up, neurological status examination remained unchanged, but the CT scan showed that the tumor was more destructive (Figure 5(a)), while the MRI revealed that it was much larger and more invasive, with the dural sac now having been encircled and compressed (Figures 5(b) and 5(c)).
Successful embolization and obstruction of the right L1, left L2, and left Th12 feeders.
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A second more complete intra-arterial embolization procedure was performed (Figures 6(a), 6(b), and 6(c)).
Arthrodesis of Th12-L2 vertebrae by iliac graft and plaque after the corpectomy of L1 by an anterolateral approach.
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Th12-L2 vertebrae by iliac graft and plaque (Figures 7(a) and 7(b)).
(a, b) MRI, axial T1WI and sagittal T2WI: the hemangioma is totally removed and the spinal cord is decompressed. (c, d) At the sixteenth year follow-up MRI, axial T1WI with gadolinium and sagittal T2WI show no recurrence.
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The immediate postoperative MRI (Figures 8(a) and 8(b)) and again the fifth year (Figures 9(a) and 9(b)) and sixteenth year follow-up MRIs (Figures 8(c) and 8(d)) showed that the lesion was totally removed, fusion was stable, the hemangioma had not recurred, the spinal canal was free, and the kyphotic angle remained unchanged. The patient returned to his daily life and work with no complication and he was free of complaints.
At the fifth year follow-up MRI, axial T1WI with gadolinium and sagittal T2WI show no recurrence.
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The immediate postoperative MRI (Figures 8(a) and 8(b)) and again the fifth year (Figures 9(a) and 9(b)) and sixteenth year follow-up MRIs (Figures 8(c) and 8(d)) showed that the lesion was totally removed, fusion was stable, the hemangioma had not recurred, the spinal canal was free, and the kyphotic angle remained unchanged. The patient returned to his daily life and work with no complication and he was free of complaints.