Atypical Vertebral Hemangiomas Are Frequently Associated with Radiculomedullary Arteries.

Authors:
Erick M Westbroek
Erick M Westbroek
University of California
United States
Zach Pennington
Zach Pennington
Johns Hopkins Hospital
Matthew L Goodwin
Matthew L Goodwin
Auburn University
United States
Yuanxuan Xia
Yuanxuan Xia
Washington University
Christine Boone
Christine Boone
Yale University School of Medicine
United States
Philippe Gailloud
Philippe Gailloud
The Johns Hopkins Hospital
Baltimore | United States
Daniel M Sciubba
Daniel M Sciubba
Johns Hopkins University School of Medicine
Baltimore | United States

World Neurosurg 2019 Apr 17. Epub 2019 Apr 17.

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: Preoperative endovascular embolization of atypical hemangiomas of the spine can reduce intraoperative blood loss. One frequent concern raised about embolizing these tumors is a possible association with arteries feeding the spinal cord, such as the artery of Adamkiewicz. This study aimed to elucidate a relationship between spinal levels affected by atypical spinal hemangiomas and radiculomedullary arteries.

Methods: This was a retrospective review of 8 patients undergoing preoperative embolization of atypical spinal hemangiomas. We evaluated 54 spinal levels by angiography during embolization procedures. Each spinal level was categorized on the basis of the presence or absence of tumor and radiculomedullary artery.

Results: Six of 15 (40%) affected levels had an associated radiculomedullary artery. Four of 39 (10.2%) unaffected levels had an associated cord feeding artery. The relative risk of affected spinal levels having an associated radiculomedullary artery was 3.9 (95% confidence interval 1.28-11.91). The attributable risk was 0.40 (95% CI 0.12-0.76). The chi-squared statistic was 6.35, with a P value of 0.01. Six of 8 patients (75%) had a radiculomedullary artery at a level of disease and embolization.

Conclusions: In this study, spinal levels affected by atypical hemangiomas requiring surgery were associated with radiculomedullary arteries. When performing preoperative embolization, great care must be taken to identify and preserve arteries supplying the spinal cord.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S18788750193109
Publisher Site
http://dx.doi.org/10.1016/j.wneu.2019.04.101DOI Listing
April 2019
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