Preoperative Sclerotherapy Using Sodium Tetradecyl Sulphate (Fibro-Vein?) Can Assist in the Management of Vertebral Hemangiomas

摘要

Vertebral hemangiomas are benign lesions accounting for 2 to 3% of all spinal tumors. They are usually asymptomatic and found incidentally on imaging. Uncommonly, vertebral hemangiomas with significant epidural extension can result in radiculopathy or spinal cord compression. Decompressive surgery with or without stabilization is often required when neurological deficits are present. However, surgery can be associated with massive hemorrhage as these tumors are hypervascular. Preoperative embolization and sclerotherapy are well-known management strategies used to minimize intraoperative bleeding and improve symptoms. Recently, the use of sclerosants such as ethanol has decreased, due to reported complications such as Brown–Sequard syndrome. We describe the use of sodium tetradecyl sulfate (Fibro-Vein?, STD Pharmaceutical, Hereford, UK) as an effective alternative to ethanol in the preoperative management of vertebral hemangiomas. To our knowledge, this has not been previously reported. In three patients, we demonstrated minimal intraoperative blood loss using a combination of preoperative embolization of arterial feeders and sclerotherapy with sodium tetradecyl sulfate to control and secure venous drainage. No patients developed complications related to the procedure. In addition to minimal blood loss, a clear dissection plane was also noted intraoperatively. Keywords: vertebral hemangioma, sclerotherapy, Fibro-Vein? Vertebral hemangiomas are benign lesions accounting for 2 to 3% of all spinal tumors. 1 They are usually asymptomatic and found incidentally on imaging. 2 Uncommonly, vertebral hemangiomas with significant epidural extension can result in radiculopathy or spinal cord compression. 2 Decompressive surgery with or without stabilization is often required when neurological deficits are present. 3 However, surgery can be associated with massive hemorrhage as these tumors are vascular. Preoperative embolization and sclerotherapy are known management options to control intraoperative bleeding. 3 Our strategy involves performing angioembolization to secure the arterial component of the vertebral hemangioma followed by sclerotherapy to control the venous component. Recently, the use of sclerosants such as ethanol has decreased due to the number of reported complications. We describe the use of sodium tetradecyl sulfate (Fibro-Vein?, STD Pharmaceutical, Hereford, UK) as an effective alternative to ethanol in the preoperative management of vertebral hemangiomas.