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O-arm navigated excision and vertebroplasty of pediatric aggressive vertebral hemangioma with compressive myelopathy: A case report

Spinal Cord Series and Cases volume 11, Article number: 20 (2025) Cite this article

Subjects

Abstract

Introduction

Vertebral hemangioma (VH) is the most common angiomatous tumor usually asymptomatic and is incidentally noticed on MRI. The incidence of VH is rare in the pediatric population. The extraosseous extension is termed an Aggressive Vertebral Hemangioma (AVH) and these often need surgical management. Intraoperative stereotactic navigation for tumor excision helps in planning- localizing the tumor and delineating its margins.

Case presentation

A 14-year-old boy presented with thoracic myelopathy signs. The MRI scan suggests T1 and T2 hyperintense signals within the T6 vertebral body with extramedullary extradural space occupying the lesion. The CT scan showed a “polka dot” appearance. Preoperative endovascular embolization followed by surgical decompression with posterior instrumented stabilization under O-arm navigation and tumor excision was planned. Cystic extradural lesion excised and vertebroplasty done at T6 level. Histopathology slides confirmed hemangioma.

Discussion

The most common age of involvement is between 30 and 70 years it is rarely seen in the pediatric age group. To the best of our knowledge, fewer than 20 cases of pediatric aggressive vertebral hemangiomas have been reported. Based on a review of pediatric AVH only 4 patients have been treated with preoperative vascular embolization followed by surgical decompression and stabilization. O-arm navigated AVH excision and vertebroplasty has never been described in the literature; this being the first case. It also aids in the identification of tumor margins along with real-time monitoring of adequate resection.

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Fig. 1: Pre-operative Xray and CT scan of the thoracic spine.
Fig. 2: Pre-operative MRI of the thoracic spine.
Fig. 3: Intraoperative endovascular embilisation, clinical and navigation screen.
Fig. 4: Intraoperative CT image, Postoperative Xray and Histopathology images.
Fig. 5: One year follow-up CT scan images.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Spine Surgery, Sancheti Institute for Orthopedics and Rehabilitation, Pune, 411005, Maharashtra, India

    Ajay R. Kothari, Nishad V. Situt, Shailesh R. Hadgaonkar, Siddharth N. Aiyer & Pramod D. Bhilare

  2. Dean, Sancheti Institute for Orthopedics and Rehabilitation, Pune, 411005, Maharashtra, India

    Parag K. Sancheti

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  1. Ajay R. Kothari
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Contributions

AK: Conceptualization, Methodology, Supervision, project administration; NS: Data curation, writing draft, visualization; SA: Modification of primary draft, investigation, review and editing, project administration; PB: Supervision, project administration; review and editing, SH and PS: Supervision, project administration. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nishad V. Situt.

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Informed consent was obtained from all individual participants included in the study.

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Approval of the institutional Ethics Committee (Sancheti Hospital Institutional Ethics Committee) has been obtained.

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This care report has been prepared in accordance with the CARE – Case report guidelines and the Declaration of Helsinki.

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Kothari, A.R., Situt, N.V., Hadgaonkar, S.R. et al. O-arm navigated excision and vertebroplasty of pediatric aggressive vertebral hemangioma with compressive myelopathy: A case report. Spinal Cord Ser Cases 11, 20 (2025). https://doi.org/10.1038/s41394-025-00717-x

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