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Alexis Moles, Olivier Hamel, Christophe Perret, Eric Bord, Roger Robert and Kevin Buffenoir

account the maternal neurological risk and the risk of fetal immaturity. In this article, we report 2 cases of symptomatic vertebral hemangioma during pregnancy, which was responsible for spontaneous vertebral fracture in 1 case, a previously unreported complication. The main aspects of the treatment decision will then be discussed in light of a brief review of the literature. Case Reports Case 1 History and Presentation The first case involved a 28-year-old woman with no notable medical history, presenting spontaneously at 35 weeks of gestation with

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Michael Zhang, Yi-Ren Chen, Steven D. Chang and Anand Veeravagu

with symptomatic vertebral hemangiomas (SVHs) may benefit from intervention. 11 The options have widely included decompression, embolization, vertebroplasty, radiation therapy, and, less frequently discussed, radiosurgery. 8 , 11 , 12 , 18 There are currently several studies in the literature discussing the response of SVH to radiation therapy. Heyd et al. reported in one of the most successful series of its size: a 40-year, multicenter review of 84 patients who were treated with a median dose of 34 Gy to achieve a 90.5% symptom response rate. 14 More recently

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Kevin C. Yao and Adel M. Malek

procedure for the management of symptomatic vertebral haemangiomas . J Bone Joint Surg Br 89 : 495 – 502 , 2007 10 Heyd R , Seegenschmiedt MH , Rades D , Winkler C , Eich HT , Bruns F , : Radiotherapy for symptomatic vertebral hemangiomas: results of a multicenter study and literature review . Int J Radiat Oncol Biol Phys 77 : 217 – 225 , 2010 11 Is M , Gezen F , Alper M , Yildiz HK , Akyuz F : Epidural extension of a lumbar vertebral haemangioma . J Clin Neurosci 13 : 687 – 690 , 2006 12 Nader R , Alford BT

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Bin Yu, Desheng Wu, Bin Shen, Weidong Zhao, Yufeng Huang, Jianguang Zhu and Dongduo Qi

V ertebral hemangiomas are the most common benign spinal neoplasms, with a reported prevalence of 10%–12% in the general population. 10 , 22 They occur most frequently in the thoracic spine, although up to 30% of lesions involve multiple levels. 10 Only 0.9%–1.2% of these tumors lead to symptoms, which include varying degrees of pain, a neurological deficit, or a combination of both, predominantly in the thoracic spine. 27 , 30 There is no consensus on the best therapeutic option for symptomatic vertebral hemangiomas. Vertebroplasty was first

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Viren S. Vasudeva, John H. Chi and Michael W. Groff

: Symptomatic hemangioma of the spine . Radiology 56 : 58 – 65 , 1951 53 McAllister VL , Kendall BE , Bull JW : Symptomatic vertebral haemangiomas . Brain 98 : 71 – 80 , 1975 54 Mohan V , Gupta SK , Tuli SM , Sanyal B : Symptomatic vertebral haemangiomas . Clin Radiol 31 : 575 – 579 , 1980 55 Murugan L , Samson RS , Chandy MJ : Management of symptomatic vertebral hemangiomas: review of 13 patients . Neurol India 50 : 300 – 305 , 2002 56 Ogawa R , Hikata T , Mikami S , Fujita N , Iwanami A , Watanabe K

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Cordell E. Gross, Charles J. Hodge Jr., Eugene F. Binet and Irvin I. Kricheff

hemangioma; a decompressive laminectomy was performed 4 days later. In our case, the relief of the subarachnoid block made further operative decompression unnecessary. The evidence is well documented that embolization of symptomatic vertebral hemangioma can reduce intraoperative hemorrhage and at times relieve the associated subarachnoid block. Therefore, consideration should be given to performing therapeutic embolization in appropriate cases of vertebral body hemangiomas causing spinal cord compression. References 1. Benati A , Da Pian R

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Krzysztof Zapałowicz, Grażyna Bierzyńska-Macyszyn, Bartłomiej Stasiów, Aleksandra Krzan, Beata Wierzycka and Anna Kopycka

and management of symptomatic and asymptomatic vertebral hemangiomas . J Neurosurg 78 : 36 – 45 , 1993 9 Hadjipavlou A , Tosounidis T , Gaitanis I , Kakavelakis K , Katonis P : Balloon kyphoplasty as a single or as an adjunct procedure for the management of symptomatic vertebral haemangiomas . J Bone Joint Surg Br 89 : 495 – 502 , 2007 10 Hao J , Hu Z : Percutaneous cement vertebroplasty in the treatment of symptomatic vertebral hemangiomas . Pain Physician 15 : 43 – 49 , 2012 11 Heary RF , Bono CM : Metastatic spinal

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Tony Feuerman, Paul S. Dwan and Ronald F. Young

15. Lozman J , Holmblad J : Cavernous hemangiomas associated with scoliosis and a localized consumptive coagulopathy. A case report. J Bone Joint Surg (Am) 58 : 1021 – 1024 , 1976 Lozman J, Holmblad J: Cavernous hemangiomas associated with scoliosis and a localized consumptive coagulopathy. A case report. J Bone Joint Surg (Am) 58: 1021–1024, 1976 16. McAllister VL , Kendall BE , Bull JWD : Symptomatic vertebral haemangiomas. Brain 98 : 71 – 80 , 1975 McAllister VL, Kendall BE, Bull

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Lorenzo Nigro

surgery for these lesions and the adjuvant role of radiotherapy or vertebroplasty. References 1 Dang L , Liu C , Yang SM , Jiang L , Liu ZJ , Liu XG , : Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance . Eur Spine J 21 : 1994 – 1999 , 2012 2 Heyd R , Seegenschmiedt MH , Rades D , Winkler C , Eich HT , Bruns F , : Radiotherapy for symptomatic vertebral hemangiomas: results of a multicenter study and literature review . Int J Radiat Oncol Biol Phys 77 : 217 – 225 , 2010 3

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H. Isaac Chen, Gregory G. Heuer, Kareem Zaghloul, Scott L. Simon, John B. Weigele and M. Sean Grady

management of symptomatic vertebral hemangiomas . Neurosurgery 58 : 287 – 295 , 2006 2 Ahn H , Jhaveri S , Yee A , Finkelstein J : Lumbar vertebral hemangioma causing cauda equina syndrome: a case report . Spine 30 : E662 – E664 , 2005 3 Bas T , Aparisi F , Bas JL : Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years . Spine 26 : 1577 – 1582 , 2001 4 Chi JH , Manley GT , Chou D : Pregnancy-related vertebral hemangioma. Case report, review of the literature, and management