Hemangiomas are benign tumors that develop from blood vessels. Hemangiomas of the skin are often visible as red, raised birthmarks that generally fade on their own. Hemangiomas can also form on internal organs. At The Spine Hospital at The Neurological Institute of New York, we specialize in hemangiomas of the spine.
Spinal hemangiomas usually develop in the bones of the spine, known as vertebrae. Most vertebral hemangiomas are located in either the thoracic (upper- to mid-) or lumbar (lower) spine. Only rarely are they found in the cervical spine (neck).
Spinal hemangiomas are widespread: they are present in about 10% of people. In fact, they are the most common benign spinal tumors. The majority of these tumors will be discovered only incidentally (in passing) or not at all, will never cause symptoms, and do not require treatment. Only spinal hemangiomas that cause pain or neurological symptoms will generally require treatment.
As tumors of blood vessels, hemangiomas have an extremely robust blood supply. When a hemangioblastoma requires surgical treatment, the neurosurgeon will often need to “map” the blood supply through a specialized study known as an angiogram. This will aid in surgical planning.
Symptoms vary depending on the size and location of the tumor; most hemangiomas cause no symptoms at all.
Among symptomatic hemangiomas, the most common symptom is pain at the tumor site, usually in the back. If the tumor expands beyond the bony boundaries or causes collapse of a vertebra it will create pressure on the surrounding nerves or spinal cord. This can lead to pain that radiates to the arms or legs, weakness, numbness, or clumsiness of the arms or legs, or compromised bowel and/or bladder control.
A vertebra weakened by a hemangioma may collapse, a painful event known as a compression fracture. Hemangiomas may also bleed, causing a hemorrhage that can expand and compress the nerves or spinal cord.
Causes and Risk Factors
Vertebral hemangiomas are most often identified in people in the fourth to sixth decades of life. They occur with equal frequency in men and women. Tumors in women are more likely to be symptomatic (cause symptoms).
Tests and Diagnosis
Vertebral hemangiomas are diagnosed by MR (magnetic resonance) imaging and/or CT (computed tomography, also known as a CAT scan). MR scans use magnets, radio waves, and computer technology to produce images of organs and tissues like the brain and spinal cord. CT scans use a combination of X-rays and computer technology to produce detailed images of bones and soft tissues.
Either of the above scans may be performed after the injection of a contrast-enhancing agent, a substance that highlights the tumor tissue within the spine. Contrast-enhancing agents may also help differentiate hemangiomas from other vertebral tumors, such as metastatic tumors.
Scans of vertebral hemangiomas usually reveal details that are characteristic of these tumors. One is the “corduroy sign,” or vertical bands of thickening in the affected bone. The bands of thickened and normal bone alternate in a pattern that looks like the stripes on corduroy. Axial scans, or scans that show a horizontal cross-section of the bone, reveal a different view–the “polka-dot sign.” This view shows circular cross-sectional “slices” of the thickened bands inside the normal bone, producing the appearance of polka-dots.
For hemangiomas that require surgical treatment, the blood supply to the tumor is defined through a specialized radiographic study known as an angiogram. During this procedure, dye is injected into blood vessels, defining the blood supply to the tumor and the architecture of vessels within the tumor. During this study, performed by neurosurgeons and neuroradiologists, agents can be injected that slow down or eliminate the flow of blood to the tumor. This procedure, known as embolization, can help treat symptoms as well as make surgical resection of these lesions much easier and safer.
When forming a treatment plan, our neurosurgeons consider the patient’s health along with the tumor’s size, location, symptoms, and blood supply.
In general, only vertebral hemangiomas that cause substantial pain or neurological symptoms will require treatment. Treatment options include radiation therapy, embolization, kyphoplasty for compression fracture, or resection (removal) of compromised bone. Instrumented fusion and fixation (placement of a bone graft and hardware such as rods and screws) may be necessary to maintain spinal stability if a substantial amount of the vertebra is involved.
Preparing for Your Appointment
Drs. Paul C. McCormick, Michael G. Kaiser, Alfred T. Ogden , Christopher E. Mandigo and Richard C.E. Anderson (Pediatric) are experts in treating vertebral hemangiomas. They can also offer you a second opinion.