Low rate of recurrence after surgical management of spinal haemangiomas

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At EuroSpine (1–3 October, Lyon, France), Nasir A Quraishi (Nottingham University Hospital NHS Trust, Centre for Spinal Studies & Surgery, Nottingham, UK) reported that data from the largest multicentre surgical cohort of spinal haemangiomas (to date) indicate that the rate of local recurrence after surgery is low and that excellent rates of long-term survival can be achieved when strict oncologic treatment principles are followed during the index surgery.

Quraishi commented that the optimum surgical management of symptomatic spinal haemangiomas (ie. requiring treatment) remains unknown as do the risk factors for recurrence and mortality after surgery. He and his co-authors (from the AOSpine International Knowledge Forum Tumour; AOSKFT), therefore, aimed to quantify the rates of local recurrence and mortality after surgical treatment and “identify prognostic variables for local disease control and death”.


They created an ambispective database of patients with primary, symptomatic spinal haemangiomas who underwent surgical treatment at one of 13 participating centres. Using secure web-based electronic data capture, Quraishi and his co-authors collected demographic, clinical, diagnostic, therapeutic, cross-sectional survival and local recurrence, and perioperative data.


Of 68 patients (63% female) with a haemangioma who underwent surgery between 1996 and 2012, 82% had pain on presentation, 55% had epidural disease, 38% had neurological dysfunction, and 31% had a pathological fracture. Quraishi reported that 39% of patients had a benign latent haemangioma, 38% had a benign active haemangioma, and 23% had a benign aggressive haemangioma. He added that just over a third (35%) underwent pre-embolisation prior to surgery and 9% received adjuvant radiation.


Local recurrence was observed in only two patients (2.9%), with one patient having a recurrence four years after surgery and the other having a recurrence after five years. Quraishi commented that because the rate of local recurrence was so low, “no clear risk factors for recurrence could be identified”. Additionally, no mortality due to the spinal haemangiomas was observed.


He concluded: “Despite the aggressive appearance of haemangiomas, formal en bloc resection is not required. Excellent rates of local control and long-term survival can be achieved.” He added that there was “no clear need for adjuvant radiation” but aggressive resection of gross disease was necessary.


Quraishi told Spinal News Internationl: “This study was developed and funded under the umbrella of the AOSKFT group with Christina Goldstein (principal investigator) and Michael Fehlings (lead principal investigator), Toronto. Going forward, it will be important to monitor our patients in a prospective manner including complications, and in particular neurological recovery where relevant for these common spinal tumours.”

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