Combination Therapy Using Embolization, Gelified Alcohol Sclerotherapy, and Vertebroplasty to Treat Aggressive Vertebral Hemangioma: Technique and Initial Results

Abstract

The study evaluated technical success, safety, and effectiveness of a nonsurgical treatment protocol combining transarterial embolization and percutaneous radiopaque gelified ethanol sclerotherapy as a first procedure, followed by vertebroplasty as a second procedure, to treat patients with aggressive vertebral hemangioma (AVH). This retrospective study included 10 patients treated for 11 hemangiomas between September 2022 and March 2024. The 11 hemangiomas were located in the cervical (n = 1), thoracic (n = 5), lumbar (n = 4), or sacral (n = 1) vertebrae. Follow-up included magnetic resonance (MR) imaging and medical consultations 1 year after the final procedure. In all cases, the procedure was technically feasible. The procedure was safe; 1 fracture occurred between sclerotherapy and cementoplasty, probably partly related to the AVH. This protocol proved to be effective, and epiduritis partially regressed on follow-up MR imaging in all patients. Further, 90% of patients noted a reduction or disappearance of pain.