{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:39:15Z","timestamp":1769726355214,"version":"3.49.0"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"23","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,12,8]]},"abstract":"\n BACKGROUND<\/jats:title>\n Aggressive vertebral hemangiomas (AVHs) are benign vascular lesions that can exhibit locally invasive behavior. Because of their rarity, standardized treatment guidelines are lacking. We present 2 surgically managed cases, supplemented with intraoperative video, and conduct a thematic literature review evaluating treatment strategies.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 66-year-old female presented with low back pain radiating to the groin and gait instability. MRI demonstrated an L1 AVH. She underwent T12\u2013L2 laminectomy, instrumented stabilization, and cement augmentation, followed by radiotherapy. Marked pain relief and functional improvement were reported. The second patient, a 14-year-old male, presented to his pediatrician with neck pain, hand weakness, and paresthesias. He sustained a fall at school and was brought to the emergency department with quadriparesis. Imaging revealed a C4\u20136 AVH with a C5 pathological fracture. Emergency C4\u20136 corpectomy, laminectomy, and posterior fixation were performed. Proximal upper extremity function partially recovered, but hand and lower extremity motor deficits persisted. A literature review demonstrated the importance of surgery and highlighted the roles of radiotherapy, cement augmentation, embolization, and alcohol-based injections in nonoperative and multimodal management.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n AVH management should be tailored based on location, extent of neural compression, and symptom severity. Surgical intervention remains central in cases with neurological compromise or instability.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25654<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25654","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:14:38Z","timestamp":1769685278000},"source":"Crossref","is-referenced-by-count":0,"title":["Thematic review and illustrative videos of aggressive vertebral column hemangioma management: illustrative cases"],"prefix":"10.3171","volume":"10","author":[{"given":"Hughes W.","family":"Benjamin","sequence":"first","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren E.","family":"Corliss","sequence":"additional","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Galgano","sequence":"additional","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill"},{"name":"Department of Neurosurgery, University of North Carolina Hospitals, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Bone Tumors: Diagnosis, Treatment, and Prognosis","first-page":"553","article-title":"Hemangioma, lymphangioma, angiomatosis\/lymphangiomatosis, glomus tumor","author":"Huvos","year":"1991","unstructured":"Huvos AG.Hemangioma, lymphangioma, angiomatosis\/lymphangiomatosis, glomus tumor. In: Huvos AG, ed. Bone Tumors: Diagnosis, Treatment, and Prognosis. 2nd ed. Saunders; 1991:553-578."},{"issue":"1","key":"bib2","series-title":"Skeletal Radiol","first-page":"25","article-title":"A systematic approach to vertebral hemangioma","volume":"44","author":"Gaudino","year":"2015","unstructured":"Gaudino SMartucci MColantonio RA systematic approach to vertebral hemangioma. Skeletal Radiol. 2015;44(1):25-36."},{"issue":"6","key":"bib3","series-title":"Spine J","first-page":"944","article-title":"Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review","volume":"14","author":"Jiang","year":"2014","unstructured":"Jiang LLiu XGYuan HSDiagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review. 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Spine J. 2023;23(9):1243-1254."},{"issue":"1","key":"bib9","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"40","article-title":"Multi-modal management of aggressive vertebral hemangioma: a single center experience","volume":"27","author":"Farouk","year":"2025","unstructured":"Farouk MKassem MAEzzeldein AAmeen MMElmokadem AHElsherbini MM.Multi-modal management of aggressive vertebral hemangioma: a single center experience. J Cerebrovasc Endovasc Neurosurg. 2025;27(1):40-49."},{"issue":"2","key":"bib10","series-title":"Neurosurg Focus","article-title":"Surgical treatment of aggressive vertebral hemangiomas","volume":"41","author":"Vasudeva","year":"2016","unstructured":"Vasudeva VSChi JHGroff MW.Surgical treatment of aggressive vertebral hemangiomas. Neurosurg Focus. 2016;41(2):E7."},{"issue":"4","key":"bib11","series-title":"J Spinal Disord Tech","first-page":"268","article-title":"Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature","volume":"24","author":"Acosta","year":"2011","unstructured":"Acosta FLSanai NCloyd JDeviren VChou DAmes CP.Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature. J Spinal Disord Tech. 2011;24(4):268-275."},{"key":"bib12","series-title":"World Neurosurg","first-page":"e474","article-title":"Long-term outcomes of excision surgery for aggressive vertebral hemangiomas","volume":"142","author":"Handa","year":"2020","unstructured":"Handa MDemura SKato SLong-term outcomes of excision surgery for aggressive vertebral hemangiomas. 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Int J Radiat Oncol Biol Phys. 2010;77(1):217-225."},{"issue":"8","key":"bib21","series-title":"Strahlentherapie","first-page":"522","volume":"153","author":"Glanzmann","year":"1977","unstructured":"Glanzmann CRust MHorst W. Radiotherapie bei Angiomen der Wirbels\u00e4ule: Ergebnisse bei 62 Patienten aus dem Zeitraum 1939-1975.Strahlentherapie. 1977;153(8):522-525."},{"issue":"3","key":"bib22","series-title":"Clin Oncol (R Coll Radiol)","first-page":"159","article-title":"Radiation therapy for symptomatic vertebral haemangioma","volume":"2","author":"Asthana","year":"1990","unstructured":"Asthana AKTandon SCPant GCSrivastava APradhan S.Radiation therapy for symptomatic vertebral haemangioma. 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Interdiscip Neurosurg. 2019;18:100560."},{"issue":"1","key":"bib25","series-title":"Int J Radiat Oncol Biol Phys","first-page":"178","article-title":"Is there a dose-effect relationship for the treatment of symptomatic vertebral hemangioma?","volume":"55","author":"Rades","year":"2003","unstructured":"Rades DBajrovic AAlberti WRudat V.Is there a dose-effect relationship for the treatment of symptomatic vertebral hemangioma? Int J Radiat Oncol Biol Phys. 2003;55(1):178-181."},{"issue":"2","key":"bib26","series-title":"J Cancer Res Ther","first-page":"199","article-title":"Symptomatic vertebral hemangioma: treatment with radiotherapy","volume":"6","author":"Aich","year":"2010","unstructured":"Aich RKDeb ARBanerjee AKarim RGupta P.Symptomatic vertebral hemangioma: treatment with radiotherapy. J Cancer Res Ther. 2010;6(2):199-203."},{"key":"bib27","series-title":"World Neurosurg","first-page":"97","article-title":"Radiosurgery for benign vertebral body hemangiomas of the spine: A systematic review and meta-analysis","volume":"164","author":"Conti","year":"2022","unstructured":"Conti AStarnoni DBarges-Coll JPapadimitriou KLevivier MTuleasca C.Radiosurgery for benign vertebral body hemangiomas of the spine: A systematic review and meta-analysis. World Neurosurg. 2022;164:97-105."},{"key":"bib28","series-title":"Radiother Oncol","first-page":"46","article-title":"Conventionally fractionated radiotherapy versus CyberKnife hypofractionated radiotherapy for painful vertebral haemangiomas\u2014a randomized clinical trial","volume":"176","author":"Miszczyk","year":"2022","unstructured":"Miszczyk MNapieralska AWo\u017aniak GConventionally fractionated radiotherapy versus CyberKnife hypofractionated radiotherapy for painful vertebral haemangiomas\u2014a randomized clinical trial. Radiother Oncol. 2022;176:46-52."},{"issue":"6","key":"bib29","series-title":"Childs Nerv Syst","first-page":"2115","article-title":"Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient","volume":"37","author":"Brunette-Cl\u00e9ment","year":"2021","unstructured":"Brunette-Cl\u00e9ment TWeil AGShedid D.Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient. Childs Nerv Syst. 2021;37(6):2115-2120."},{"issue":"7","key":"bib30","series-title":"Neuroradiology","first-page":"471","article-title":"Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up","volume":"51","author":"Guarnieri","year":"2009","unstructured":"Guarnieri GAmbrosanio GVassallo PVertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up. Neuroradiology. 2009;51(7):471-476."},{"issue":"7","key":"bib31","series-title":"Eur Radiol","first-page":"2860","article-title":"Long-term outcome of percutaneous alcohol embolization combined with percutaneous vertebroplasty in aggressive vertebral hemangiomas with epidural extension","volume":"27","author":"Premat","year":"2017","unstructured":"Premat KClaren\u00e7on FCormier \u00c9Long-term outcome of percutaneous alcohol embolization combined with percutaneous vertebroplasty in aggressive vertebral hemangiomas with epidural extension. Eur Radiol. 2017;27(7):2860-2867."},{"issue":"1","key":"bib32","series-title":"J Neurointerv Surg","first-page":"neurintsurg-2020-016785","article-title":"Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas","volume":"14","author":"Roscop","year":"2022","unstructured":"Roscop CGariel FKieser DCDoughnut vertebroplasty for circumferential aggressive vertebral hemangiomas. J Neurointerv Surg. 2022;14(1):neurintsurg-2020-016785."},{"issue":"5","key":"bib33","series-title":"J Vasc Interv Radiol","first-page":"681","article-title":"Transarterial embolization of vertebral hemangioma","volume":"4","author":"Smith","year":"1993","unstructured":"Smith TPKoci TMehringer CMTransarterial embolization of vertebral hemangioma. J Vasc Interv Radiol. 1993;4(5):681-685."},{"issue":"2","key":"bib34","series-title":"Radiology","first-page":"341","article-title":"Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol","volume":"214","author":"Doppman","year":"2000","unstructured":"Doppman JLOldfield EHHeiss JD.Symptomatic vertebral hemangiomas: treatment by means of direct intralesional injection of ethanol. Radiology. 2000;214(2):341-348."},{"issue":"1","key":"bib35","series-title":"Neurosurgery","first-page":"78","article-title":"Treatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study","volume":"68","author":"Singh","year":"2011","unstructured":"Singh PMishra NKDash HHTreatment of vertebral hemangiomas with absolute alcohol (ethanol) embolization, cord decompression, and single level instrumentation: a pilot study. Neurosurgery. 2011;68(1):78-84."},{"key":"bib1","series-title":"Bone Tumors: Diagnosis, Treatment, and Prognosis","first-page":"553","article-title":"Hemangioma, lymphangioma, angiomatosis\/lymphangiomatosis, glomus tumor","author":"Huvos","year":"1991","unstructured":"Huvos AG.Hemangioma, lymphangioma, angiomatosis\/lymphangiomatosis, glomus tumor. In: Huvos AG, ed. Bone Tumors: Diagnosis, Treatment, and Prognosis. 2nd ed. Saunders; 1991:553-578."},{"issue":"1","key":"bib2","series-title":"Skeletal Radiol","first-page":"25","article-title":"A systematic approach to vertebral hemangioma","volume":"44","author":"Gaudino","year":"2015","unstructured":"Gaudino SMartucci MColantonio RA systematic approach to vertebral hemangioma. Skeletal Radiol. 2015;44(1):25-36."},{"issue":"6","key":"bib3","series-title":"Spine J","first-page":"944","article-title":"Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review","volume":"14","author":"Jiang","year":"2014","unstructured":"Jiang LLiu XGYuan HSDiagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review. Spine J. 2014;14(6):944-954."},{"issue":"1","key":"bib4","series-title":"J Orthop Surg Res","first-page":"310","article-title":"Vertebral hemangiomas: a review on diagnosis and management","volume":"19","author":"Kato","year":"2024","unstructured":"Kato KTeferi NChalla MEschbacher KYamaguchi S.Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res. 2024;19(1):310."},{"issue":"6","key":"bib5","series-title":"Eur Radiol","first-page":"997","article-title":"Imaging of compressive vertebral haemangiomas","volume":"10","author":"Cross","year":"2000","unstructured":"Cross JJAntoun NMLaing RJXuereb J.Imaging of compressive vertebral haemangiomas. Eur Radiol. 2000;10(6):997-1002."},{"issue":"1","key":"bib6","series-title":"Radiology","first-page":"183","article-title":"Vertebral hemangiomas: radiologic evaluation","volume":"161","author":"Laredo","year":"1986","unstructured":"Laredo JDReizine DBard MMerland JJ.Vertebral hemangiomas: radiologic evaluation. Radiology. 1986;161(1):183-189."},{"key":"bib7","series-title":"Surg Neurol Int","first-page":"56","article-title":"Surgical management of symptomatic vertebral hemangiomas: a case report and literature review","volume":"12","author":"Chopra","year":"2021","unstructured":"Chopra HHoffman HRichardson TEGalgano MA.Surgical management of symptomatic vertebral hemangiomas: a case report and literature review. Surg Neurol Int. 2021;12:56."},{"issue":"9","key":"bib8","series-title":"Spine J","first-page":"1243","article-title":"Surgical management of symptomatic vertebral hemangiomas: a single institution experience and literature review","volume":"23","author":"Teferi","year":"2023","unstructured":"Teferi NChowdhury AJMehdi ZSurgical management of symptomatic vertebral hemangiomas: a single institution experience and literature review. Spine J. 2023;23(9):1243-1254."},{"issue":"1","key":"bib9","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"40","article-title":"Multi-modal management of aggressive vertebral hemangioma: a single center experience","volume":"27","author":"Farouk","year":"2025","unstructured":"Farouk MKassem MAEzzeldein AAmeen MMElmokadem AHElsherbini MM.Multi-modal management of aggressive vertebral hemangioma: a single center experience. J Cerebrovasc Endovasc Neurosurg. 2025;27(1):40-49."},{"issue":"2","key":"bib10","series-title":"Neurosurg Focus","article-title":"Surgical treatment of aggressive vertebral hemangiomas","volume":"41","author":"Vasudeva","year":"2016","unstructured":"Vasudeva VSChi JHGroff MW.Surgical treatment of aggressive vertebral hemangiomas. Neurosurg Focus. 2016;41(2):E7."},{"issue":"4","key":"bib11","series-title":"J Spinal Disord Tech","first-page":"268","article-title":"Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature","volume":"24","author":"Acosta","year":"2011","unstructured":"Acosta FLSanai NCloyd JDeviren VChou DAmes CP.Treatment of Enneking stage 3 aggressive vertebral hemangiomas with intralesional spondylectomy: report of 10 cases and review of the literature. J Spinal Disord Tech. 2011;24(4):268-275."},{"key":"bib12","series-title":"World Neurosurg","first-page":"e474","article-title":"Long-term outcomes of excision surgery for aggressive vertebral hemangiomas","volume":"142","author":"Handa","year":"2020","unstructured":"Handa MDemura SKato SLong-term outcomes of excision surgery for aggressive vertebral hemangiomas. World Neurosurg. 2020;142:e474-e480."},{"issue":"9","key":"bib13","series-title":"Spine (Phila Pa 1976)","first-page":"656","article-title":"Spinal hemangiomas: results of surgical management for local recurrence and mortality in a multicenter study","volume":"40","author":"Goldstein","year":"2015","unstructured":"Goldstein CLVarga PPGokaslan ZLSpinal hemangiomas: results of surgical management for local recurrence and mortality in a multicenter study. Spine (Phila Pa 1976). 2015;40(9):656-664."},{"issue":"1","key":"bib14","series-title":"Neurosurg Clin N Am","first-page":"17","article-title":"Comprehensive management of symptomatic and aggressive vertebral hemangiomas","volume":"19","author":"Acosta","year":"2008","unstructured":"Acosta FLSanai NChi JHComprehensive management of symptomatic and aggressive vertebral hemangiomas. 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Int J Radiat Oncol Biol Phys. 2010;77(1):217-225."},{"issue":"8","key":"bib21","series-title":"Strahlentherapie","first-page":"522","volume":"153","author":"Glanzmann","year":"1977","unstructured":"Glanzmann CRust MHorst W. Radiotherapie bei Angiomen der Wirbels\u00e4ule: Ergebnisse bei 62 Patienten aus dem Zeitraum 1939-1975.Strahlentherapie. 1977;153(8):522-525."},{"issue":"3","key":"bib22","series-title":"Clin Oncol (R Coll Radiol)","first-page":"159","article-title":"Radiation therapy for symptomatic vertebral haemangioma","volume":"2","author":"Asthana","year":"1990","unstructured":"Asthana AKTandon SCPant GCSrivastava APradhan S.Radiation therapy for symptomatic vertebral haemangioma. 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