{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T23:09:39Z","timestamp":1784675379798,"version":"3.55.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Hemangiomas are common benign vascular lesions that rarely present with pain and neurological deficits. Symptomatic lesions are often treated with endovascular embolization. However, transarterial embolization can be technically challenging depending on the size and caliber of the vessels. Moreover, embolization can result in osteonecrosis and vertebral collapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Here the authors report the first case of a T10 vertebral hemangioma treated with transpedicular Onyx embolization aided by a robotic platform that guided pedicle cannulation and Craig needle placement. An intravenous catheter was attached to the needle and dimethylsulfoxide was infused, followed by Onyx under real-time fluoroscopy. Repeat angiography demonstrated significantly reduced contrast opacification of the vertebral body without compromise of the segmental artery. A T9\u201311 pedicle screw fixation was performed to optimize long-term stability. The patient\u2019s symptoms improved and was stable at the 6-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Transpedicular embolization of vertebral hemangiomas can be performed successfully under robotic navigation guidance, avoiding complications seen with the intra-arterial approach and allowing for simultaneous pedicle screw fixation to prevent collapse and delayed kyphotic deformity. During the same procedure, a biopsy specimen can be collected for pathology. This technique can help to alleviate patient symptoms while avoiding complications associated with transarterial embolization or open resection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2348","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T02:17:04Z","timestamp":1687832224000},"source":"Crossref","is-referenced-by-count":3,"title":["Transpedicular Onyx embolization of a thoracic hemangioma with robotic assistance: illustrative case"],"prefix":"10.3171","volume":"5","author":[{"given":"Andrew M.","family":"Hersh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yike","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risheng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Daniel","family":"Davidar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly","family":"Weber-Levine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Fernando","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"StatPearls","article-title":"Spinal Hemangioma","author":"Tafti D","unstructured":"Tafti D, Cecava ND. Spinal Hemangioma. StatPearls. Published online January 2, 2022."},{"issue":"1","key":"b2","series-title":"J Neurosurg Spine","first-page":"80","article-title":"Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report","volume":"7","author":"Chen HI","year":"2007","unstructured":"Chen HI, Heuer GG, Zaghloul K, Simon SL, Weigele JB, Grady MS. Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report. J Neurosurg Spine. 2007; 7(1):80\u201385.17633493"},{"issue":"5","key":"b3","series-title":"Spine J","first-page":"595","article-title":"Acute spinal cord compression caused by vertebral hemangioma","volume":"4","author":"Templin CR","year":"2004","unstructured":"Templin CR, Stambough JB, Stambough JL. Acute spinal cord compression caused by vertebral hemangioma. Spine J. 2004;4(5):595\u2013600.15363434"},{"issue":"2","key":"b4","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgical treatment of aggressive vertebral hemangiomas","volume":"41","author":"Vasudeva VS","year":"2016","unstructured":"Vasudeva VS, Chi JH, Groff MW. Surgical treatment of aggressive vertebral hemangiomas. Neurosurg Focus. 2016;41(2):E7.27476849"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1204","article-title":"The utility of onyx for preoperative embolization of cranial and spinal tumors","volume":"62","author":"Gore P","year":"2008","unstructured":"Gore P, Theodore N, Brasiliense L,  The utility of onyx for preoperative embolization of cranial and spinal tumors. Neurosurgery. 2008;62(6):1204\u20131212.18824987"},{"issue":"6","key":"b6","series-title":"AJNR Am J Neuroradiol","first-page":"1095","article-title":"Preoperative Onyx embolization of aggressive vertebral hemangiomas","volume":"29","author":"Hurley MC","year":"2008","unstructured":"Hurley MC, Gross BA, Surdell D,  Preoperative Onyx embolization of aggressive vertebral hemangiomas. AJNR Am J Neuroradiol. 2008;29(6):1095\u20131097.18372419"},{"issue":"4","key":"b7","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"320","article-title":"Intra-arterial Onyx embolization of vertebral body lesions","volume":"15","author":"Sedora-Roman NI","year":"2013","unstructured":"Sedora-Roman NI, Gross BA, Reddy AS, Ogilvy CS, Thomas AJ. Intra-arterial Onyx embolization of vertebral body lesions. J Cerebrovasc Endovasc Neurosurg. 2013;15(4):320\u2013325.24729960"},{"issue":"1","key":"b8","series-title":"J Neurointerv Surg","first-page":"51","article-title":"Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors: experience with 100 consecutive cases from a single tertiary center","volume":"6","author":"Rangel-Castilla L","year":"2014","unstructured":"Rangel-Castilla L, Shah AH, Klucznik RP, Diaz OM. Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors: experience with 100 consecutive cases from a single tertiary center. J Neurointerv Surg. 2014;6(1):51\u201356.23268473"},{"key":"b9","series-title":"Interdiscip Neurosurg","first-page":"100968","article-title":"Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up","volume":"23","author":"Gupta AK","year":"2021","unstructured":"Gupta AK, Phukan P, Bodhey N. Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up. Interdiscip Neurosurg. 2021;23:100968."},{"issue":"12","key":"b10","series-title":"Clin Neurol Neurosurg","first-page":"2457","article-title":"Preoperative spinal tumor embolization: an institutional experience with Onyx","volume":"115","author":"Ghobrial GM","year":"2013","unstructured":"Ghobrial GM, Chalouhi N, Harrop J,  Preoperative spinal tumor embolization: an institutional experience with Onyx. Clin Neurol Neurosurg. 2013;115(12):2457\u20132463.24169150"},{"issue":"6","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"1091","article-title":"Alcohol ablation of symptomatic vertebral hemangiomas","volume":"20","author":"Goyal M","year":"1999","unstructured":"Goyal M, Mishra NK, Sharma A, Gaikwad SB, Mohanty BK, Sharma S. Alcohol ablation of symptomatic vertebral hemangiomas. 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J Spinal Disord Tech. 2011;24(3):196\u2013201.21508725"},{"issue":"4","key":"b14","series-title":"Br J Neurosurg","first-page":"381","article-title":"Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas","volume":"32","author":"Eichberg DG","year":"2018","unstructured":"Eichberg DG, Starke RM, Levi AD. Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas. Br J Neurosurg. 2018;32(4):381\u2013388.28682125"},{"issue":"3","key":"b15","series-title":"Surg Neurol","first-page":"164","article-title":"Vertebral hemangiomas with cord compression: the role of embolization in five cases","volume":"34","author":"Raco A","year":"1990","unstructured":"Raco A, Ciappetta P, Artico M, Salvati M, Guidetti G, Guglielmi G. Vertebral hemangiomas with cord compression: the role of embolization in five cases. Surg Neurol. 1990;34(3):164\u2013168.2385824"},{"issue":"2","key":"b16","series-title":"Neurosurgery","first-page":"287","article-title":"Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas","volume":"58","author":"Acosta FL Jr","year":"2006","unstructured":"Acosta FL Jr, Dowd CF, Chin C, Tihan T, Ames CP, Weinstein PR. Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery. 2006;58(2):287\u2013295.16462482"},{"issue":"1","key":"b17","series-title":"Neurosurg Clin N Am","first-page":"17","article-title":"Comprehensive management of symptomatic and aggressive vertebral hemangiomas","volume":"19","author":"Acosta FL Jr","year":"2008","unstructured":"Acosta FL Jr, Sanai N, Chi JH,  Comprehensive management of symptomatic and aggressive vertebral hemangiomas. Neurosurg Clin N Am. 2008;19(1):17\u201329.18156044"},{"issue":"3","key":"b18","series-title":"Asian Spine J","first-page":"483","article-title":"Blood loss in surgery for aggressive vertebral haemangioma with and without embolisation","volume":"9","author":"Robinson Y","year":"2015","unstructured":"Robinson Y, Sheta R, Salci K, Willander J. Blood loss in surgery for aggressive vertebral haemangioma with and without embolisation. Asian Spine J. 2015;9(3):483\u2013491."},{"issue":"5\u20136","key":"b19","series-title":"Minim Invasive Neurosurg","first-page":"275","article-title":"Minimally invasive decompression and stabilisation for extensive haemangiomas of lumbar spine","volume":"53","author":"Gnanalingham KK","year":"2010","unstructured":"Gnanalingham KK, Afridi MB, Abou-Zeid A, Herwadkar A. Minimally invasive decompression and stabilisation for extensive haemangiomas of lumbar spine. Minim Invasive Neurosurg. 2010;53(5\u20136):275\u2013278.21302198"},{"issue":"5","key":"b20","series-title":"J Vasc Interv Radiol","first-page":"681","article-title":"Transarterial embolization of vertebral hemangioma","volume":"4","author":"Smith TP","year":"1993","unstructured":"Smith TP, Koci T, Mehringer CM,  Transarterial embolization of vertebral hemangioma. J Vasc Interv Radiol. 1993;4(5):681\u2013685.8219564"},{"issue":"8","key":"b21","series-title":"Spinal Cord","first-page":"636","article-title":"Brown-Sequard syndrome after endovascular embolization of vertebral hemangioma","volume":"50","author":"Fernandez-Torron R","year":"2012","unstructured":"Fernandez-Torron R, Palma JA, Riverol M, Irimia P, Martinez-Vila E. Brown-Sequard syndrome after endovascular embolization of vertebral hemangioma. Spinal Cord. 2012;50(8):636\u2013637.22310318"},{"issue":"2","key":"b22","series-title":"Oper Neurosurg (Hagerstown)","first-page":"E17","article-title":"Intraoperative transpedicular onyx injection to reduce vascularity of a thoracic hemangiopericytoma after unsuccessful preoperative endovascular embolization: a technical report","volume":"14","author":"Mashaly H","year":"2018","unstructured":"Mashaly H, Zhang Z, Shaw A, Youssef P, Mendel E. Intraoperative transpedicular onyx injection to reduce vascularity of a thoracic hemangiopericytoma after unsuccessful preoperative endovascular embolization: a technical report. Oper Neurosurg (Hagerstown). 2018;14(2):E17\u2013E22.29351687"},{"issue":"3","key":"b23","series-title":"Oper Neurosurg (Hagerstown)","first-page":"E86","article-title":"Minimally invasive transforaminal interbody fusion with robotically assisted bilateral pedicle screw fixation: 2-dimensional operative video","volume":"16","author":"Godzik J","year":"2019","unstructured":"Godzik J, Walker CT, Theodore N, Uribe JS, Chang SW, Snyder LA. Minimally invasive transforaminal interbody fusion with robotically assisted bilateral pedicle screw fixation: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2019;16(3):E86\u2013E87.30252105"},{"key":"b1","series-title":"StatPearls","article-title":"Spinal Hemangioma","author":"Tafti D","unstructured":"Tafti D, Cecava ND. Spinal Hemangioma. StatPearls. Published online January 2, 2022."},{"issue":"1","key":"b2","series-title":"J Neurosurg Spine","first-page":"80","article-title":"Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report","volume":"7","author":"Chen HI","year":"2007","unstructured":"Chen HI, Heuer GG, Zaghloul K, Simon SL, Weigele JB, Grady MS. Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report. J Neurosurg Spine. 2007; 7(1):80\u201385.17633493"},{"issue":"5","key":"b3","series-title":"Spine J","first-page":"595","article-title":"Acute spinal cord compression caused by vertebral hemangioma","volume":"4","author":"Templin CR","year":"2004","unstructured":"Templin CR, Stambough JB, Stambough JL. Acute spinal cord compression caused by vertebral hemangioma. Spine J. 2004;4(5):595\u2013600.15363434"},{"issue":"2","key":"b4","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgical treatment of aggressive vertebral hemangiomas","volume":"41","author":"Vasudeva VS","year":"2016","unstructured":"Vasudeva VS, Chi JH, Groff MW. Surgical treatment of aggressive vertebral hemangiomas. Neurosurg Focus. 2016;41(2):E7.27476849"},{"issue":"6","key":"b5","series-title":"Neurosurgery","first-page":"1204","article-title":"The utility of onyx for preoperative embolization of cranial and spinal tumors","volume":"62","author":"Gore P","year":"2008","unstructured":"Gore P, Theodore N, Brasiliense L,  The utility of onyx for preoperative embolization of cranial and spinal tumors. Neurosurgery. 2008;62(6):1204\u20131212.18824987"},{"issue":"6","key":"b6","series-title":"AJNR Am J Neuroradiol","first-page":"1095","article-title":"Preoperative Onyx embolization of aggressive vertebral hemangiomas","volume":"29","author":"Hurley MC","year":"2008","unstructured":"Hurley MC, Gross BA, Surdell D,  Preoperative Onyx embolization of aggressive vertebral hemangiomas. AJNR Am J Neuroradiol. 2008;29(6):1095\u20131097.18372419"},{"issue":"4","key":"b7","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"320","article-title":"Intra-arterial Onyx embolization of vertebral body lesions","volume":"15","author":"Sedora-Roman NI","year":"2013","unstructured":"Sedora-Roman NI, Gross BA, Reddy AS, Ogilvy CS, Thomas AJ. Intra-arterial Onyx embolization of vertebral body lesions. J Cerebrovasc Endovasc Neurosurg. 2013;15(4):320\u2013325.24729960"},{"issue":"1","key":"b8","series-title":"J Neurointerv Surg","first-page":"51","article-title":"Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors: experience with 100 consecutive cases from a single tertiary center","volume":"6","author":"Rangel-Castilla L","year":"2014","unstructured":"Rangel-Castilla L, Shah AH, Klucznik RP, Diaz OM. Preoperative Onyx embolization of hypervascular head, neck, and spinal tumors: experience with 100 consecutive cases from a single tertiary center. J Neurointerv Surg. 2014;6(1):51\u201356.23268473"},{"key":"b9","series-title":"Interdiscip Neurosurg","first-page":"100968","article-title":"Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up","volume":"23","author":"Gupta AK","year":"2021","unstructured":"Gupta AK, Phukan P, Bodhey N. Percutaneous vertebroplasty for the treatment of symptomatic vertebral hemangioma with long-term follow-up. Interdiscip Neurosurg. 2021;23:100968."},{"issue":"12","key":"b10","series-title":"Clin Neurol Neurosurg","first-page":"2457","article-title":"Preoperative spinal tumor embolization: an institutional experience with Onyx","volume":"115","author":"Ghobrial GM","year":"2013","unstructured":"Ghobrial GM, Chalouhi N, Harrop J,  Preoperative spinal tumor embolization: an institutional experience with Onyx. Clin Neurol Neurosurg. 2013;115(12):2457\u20132463.24169150"},{"issue":"6","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"1091","article-title":"Alcohol ablation of symptomatic vertebral hemangiomas","volume":"20","author":"Goyal M","year":"1999","unstructured":"Goyal M, Mishra NK, Sharma A, Gaikwad SB, Mohanty BK, Sharma S. Alcohol ablation of symptomatic vertebral hemangiomas. AJNR Am J Neuroradiol. 1999;20(6):1091\u20131096.10445448"},{"issue":"1","key":"b12","series-title":"J Neurosurg","first-page":"36","article-title":"The natural history and management of symptomatic and asymptomatic vertebral hemangiomas","volume":"78","author":"Fox MW","year":"1993","unstructured":"Fox MW, Onofrio BM. The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg. 1993;78(1):36\u201345.8416240"},{"issue":"3","key":"b13","series-title":"J Spinal Disord Tech","first-page":"196","article-title":"Management of symptomatic vertebral hemangioma: follow-up of 6 patients","volume":"24","author":"Blecher R","year":"2011","unstructured":"Blecher R, Smorgick Y, Anekstein Y, Peer A, Mirovsky Y. Management of symptomatic vertebral hemangioma: follow-up of 6 patients. J Spinal Disord Tech. 2011;24(3):196\u2013201.21508725"},{"issue":"4","key":"b14","series-title":"Br J Neurosurg","first-page":"381","article-title":"Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas","volume":"32","author":"Eichberg DG","year":"2018","unstructured":"Eichberg DG, Starke RM, Levi AD. Combined surgical and endovascular approach for treatment of aggressive vertebral haemangiomas. Br J Neurosurg. 2018;32(4):381\u2013388.28682125"},{"issue":"3","key":"b15","series-title":"Surg Neurol","first-page":"164","article-title":"Vertebral hemangiomas with cord compression: the role of embolization in five cases","volume":"34","author":"Raco A","year":"1990","unstructured":"Raco A, Ciappetta P, Artico M, Salvati M, Guidetti G, Guglielmi G. Vertebral hemangiomas with cord compression: the role of embolization in five cases. Surg Neurol. 1990;34(3):164\u2013168.2385824"},{"issue":"2","key":"b16","series-title":"Neurosurgery","first-page":"287","article-title":"Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas","volume":"58","author":"Acosta FL Jr","year":"2006","unstructured":"Acosta FL Jr, Dowd CF, Chin C, Tihan T, Ames CP, Weinstein PR. Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery. 2006;58(2):287\u2013295.16462482"},{"issue":"1","key":"b17","series-title":"Neurosurg Clin N Am","first-page":"17","article-title":"Comprehensive management of symptomatic and aggressive vertebral hemangiomas","volume":"19","author":"Acosta FL Jr","year":"2008","unstructured":"Acosta FL Jr, Sanai N, Chi JH,  Comprehensive management of symptomatic and aggressive vertebral hemangiomas. Neurosurg Clin N Am. 2008;19(1):17\u201329.18156044"},{"issue":"3","key":"b18","series-title":"Asian Spine J","first-page":"483","article-title":"Blood loss in surgery for aggressive vertebral haemangioma with and without embolisation","volume":"9","author":"Robinson Y","year":"2015","unstructured":"Robinson Y, Sheta R, Salci K, Willander J. Blood loss in surgery for aggressive vertebral haemangioma with and without embolisation. Asian Spine J. 2015;9(3):483\u2013491."},{"issue":"5\u20136","key":"b19","series-title":"Minim Invasive Neurosurg","first-page":"275","article-title":"Minimally invasive decompression and stabilisation for extensive haemangiomas of lumbar spine","volume":"53","author":"Gnanalingham KK","year":"2010","unstructured":"Gnanalingham KK, Afridi MB, Abou-Zeid A, Herwadkar A. Minimally invasive decompression and stabilisation for extensive haemangiomas of lumbar spine. 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Oper Neurosurg (Hagerstown). 2018;14(2):E17\u2013E22.29351687"},{"issue":"3","key":"b23","series-title":"Oper Neurosurg (Hagerstown)","first-page":"E86","article-title":"Minimally invasive transforaminal interbody fusion with robotically assisted bilateral pedicle screw fixation: 2-dimensional operative video","volume":"16","author":"Godzik J","year":"2019","unstructured":"Godzik J, Walker CT, Theodore N, Uribe JS, Chang SW, Snyder LA. Minimally invasive transforaminal interbody fusion with robotically assisted bilateral pedicle screw fixation: 2-dimensional operative video. 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