{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:14Z","timestamp":1776096494277,"version":"3.50.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"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":[[2026,1,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Aggressive vertebral hemangiomas are uncommon vascular spinal lesions that may enlarge during pregnancy due to hormonal and hemodynamic changes. Elevated estrogen and progesterone levels, increased blood volume, and venous congestion can lead to rapid lesion expansion and epidural extension, causing neurological deficits. Although rare, these lesions should be considered in pregnant or postpartum women presenting with back or radicular pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 30-year-old woman with epilepsy controlled by lamotrigine developed progressive low back and right leg pain during late pregnancy, worsening postpartum. MRI revealed an aggressive L4 vertebral hemangioma with epidural extension compressing the thecal sac and right L4 nerve root. The patient underwent L4 laminectomy, excision of the epidural component, and vertebroplasty. Persistent bleeding after initial posterior cement injection required a second injection through the left pedicle to fill the superior vertebral body, followed by fibrin glue application. She was mobilized on the 1st postoperative day, and her symptoms resolved completely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Pregnancy-related aggressive vertebral hemangioma should be suspected in women with new-onset neurological symptoms during pregnancy or postpartum. Early diagnosis, multidisciplinary planning, and timely decompression with vertebroplasty yield excellent neurological recovery and functional outcomes.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25860\">https:\/\/thejns.org\/doi\/10.3171\/CASE25860<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25860","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T06:29:08Z","timestamp":1769408948000},"source":"Crossref","is-referenced-by-count":0,"title":["Pregnancy-related aggressive vertebral hemangioma presenting with radiculopathy: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9246-1378","authenticated-orcid":true,"given":"Cafer Ikbal","family":"Gulsever","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hakkari State Hospital, Hakkari"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7889-3396","authenticated-orcid":true,"given":"Serdar","family":"Solmaz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hakkari State Hospital, Hakkari"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7772-6331","authenticated-orcid":true,"given":"Metehan","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Corlu State Hospital, Tekirdag, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"36","article-title":"The natural history and management of symptomatic and asymptomatic vertebral hemangiomas","volume":"78","author":"Fox","year":"1993","unstructured":"Fox MWOnofrio BM.The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg. 1993;78(1):36-45."},{"issue":"2","key":"bib2","series-title":"Neurosurgery","first-page":"287","article-title":"Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas","volume":"58","author":"Acosta","year":"2006","unstructured":"Acosta FLDowd CFChin CTihan TAmes CPWeinstein PR.Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery. 2006;58(2):287-295."},{"issue":"3","key":"bib3","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Pregnancy-related vertebral hemangioma. Case report, review of the literature, and management algorithm","volume":"19","author":"Chi","year":"2005","unstructured":"Chi JHManley GTChou D.Pregnancy-related vertebral hemangioma. Case report, review of the literature, and management algorithm. Neurosurg Focus. 2005;19(3):E7."},{"issue":"5","key":"bib4","series-title":"J Neurosurg Spine","first-page":"585","article-title":"Symptomatic vertebral hemangiomas during pregnancy","volume":"20","author":"Moles","year":"2014","unstructured":"Moles AHamel OPerret CBord ERobert RBuffenoir K.Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine. 2014;20(5):585-591."},{"issue":"40","key":"bib5","series-title":"Medicine (Baltimore)","first-page":"e12724","article-title":"Progression of aggressive vertebral hemangiomas during pregnancy: three case reports and literature review","volume":"97","author":"Wang","year":"2018","unstructured":"Wang BJiang LWei FLiu XGLiu ZJ.Progression of aggressive vertebral hemangiomas during pregnancy: three case reports and literature review. Medicine (Baltimore). 2018;97(40):e12724."},{"key":"bib6","series-title":"J Med Case Rep","first-page":"207","article-title":"An aggressive vertebral hemangioma in pregnancy: a case report","volume":"8","author":"Slimani","year":"2014","unstructured":"Slimani OJayi SFdili Alaoui FAn aggressive vertebral hemangioma in pregnancy: a case report. J Med Case Rep. 2014;8:207."},{"key":"bib7","series-title":"Surg Neurol Int","first-page":"105","article-title":"Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: case report and review of the literature","volume":"8","author":"Fereydonyan","year":"2017","unstructured":"Fereydonyan NTaheri MKazemi F.Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: case report and review of the literature. Surg Neurol Int. 2017;8:105."},{"issue":"8","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"888","article-title":"Vertebral arch hemangioma producing spinal cord compression in pregnancy. Diagnosis by magnetic resonance imaging","volume":"14","author":"Schwartz","year":"1989","unstructured":"Schwartz DANair SHershey BWinkelman ACFinkelstein SD.Vertebral arch hemangioma producing spinal cord compression in pregnancy. Diagnosis by magnetic resonance imaging. Spine (Phila Pa 1976). 1989;14(8):888-890."},{"issue":"suppl 2","key":"bib9","series-title":"Eur Spine J","first-page":"S299","article-title":"Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature","volume":"17","author":"Vijay","year":"2008","unstructured":"Vijay KShetty APRajasekaran S.Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature. 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Surg Neurol Int. 2021;12:150."},{"issue":"4","key":"bib12","series-title":"Radiographics","first-page":"1019","article-title":"Diagnostic imaging of solitary tumors of the spine: what to do and say","volume":"28","author":"Rodallec","year":"2008","unstructured":"Rodallec MHFeydy ALarousserie FDiagnostic imaging of solitary tumors of the spine: what to do and say. Radiographics. 2008;28(4):1019-1041."},{"issue":"5","key":"bib13","series-title":"Isr Med Assoc J","first-page":"311","article-title":"Symptomatic spinal hemangioma in pregnancy","volume":"12","author":"Blecher","year":"2010","unstructured":"Blecher RSmorgick YMirovsky Y.Symptomatic spinal hemangioma in pregnancy. 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Neurochirurgie. 1987;33(2):166-168."},{"issue":"8","key":"bib16","series-title":"Neurol Med Chir (Tokyo)","first-page":"674","article-title":"Symptomatic T2 vertebral hemangioma in a pregnant woman treated by one stage combination surgery; posterior stabilization and anterior subtotal tumor resection. Case report","volume":"50","author":"Shinozaki","year":"2010","unstructured":"Shinozaki MMorita AKamijo KSeichi ASaito NKirino T.Symptomatic T2 vertebral hemangioma in a pregnant woman treated by one stage combination surgery; posterior stabilization and anterior subtotal tumor resection. Case report. 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J Obstet Gynaecol India. 2018;69(2):185-187."},{"issue":"7","key":"bib19","series-title":"Oxf Med Case Rep","first-page":"122","article-title":"Aggressive vertebral hemangioma in the postpartum period: an eye-opener","volume":"2014","author":"Jain","year":"2014","unstructured":"Jain RSAgrawal RSrivastava TKumar SGupta PKKookna JC.Aggressive vertebral hemangioma in the postpartum period: an eye-opener. Oxf Med Case Rep. 2014;2014(7):122-124."},{"issue":"2","key":"bib20","series-title":"Neurosurgery","first-page":"302","article-title":"Vertebral hemangioma symptomatic during pregnancy\u2014report of a case and review of the literature","volume":"32","author":"Tekk\u00f6k","year":"1993","unstructured":"Tekk\u00f6k IHA\u00e7\u00eckg\u00f6z BSa\u011flam S\u00d6nol B.Vertebral hemangioma symptomatic during pregnancy\u2014report of a case and review of the literature. Neurosurgery. 1993;32(2):302-306."},{"key":"bib21","series-title":"Womens Health (Lond)","first-page":"17455057221099018","article-title":"Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma","volume":"18","author":"Ridzo\u0148ov\u00e1","year":"2022","unstructured":"Ridzo\u0148ov\u00e1 LFedi\u010dov\u00e1 MAndr\u00e1\u0161 TUrdz\u00edk PGdovinov\u00e1 Z.Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma. Womens Health (Lond). 2022;18:17455057221099018."},{"issue":"6","key":"bib22","series-title":"BMJ Case Rep","first-page":"e250306","article-title":"Spinal haemangioma with cauda equina syndrome in pregnancy","volume":"15","author":"Raj","year":"2022","unstructured":"Raj AAbraham ARaja Navaneethan PMathew V.Spinal haemangioma with cauda equina syndrome in pregnancy. BMJ Case Rep. 2022;15(6):e250306."},{"issue":"5","key":"bib23","series-title":"Emerg Radiol","first-page":"259","article-title":"Symptomatic vertebral hemangioma related to pregnancy","volume":"13","author":"Yuksel","year":"2007","unstructured":"Yuksel MYuksel KZTuncel DZencirci BBakaris S.Symptomatic vertebral hemangioma related to pregnancy. Emerg Radiol. 2007;13(5):259-263."},{"issue":"1","key":"bib24","series-title":"Ginekol Pol","first-page":"62","article-title":"Symptomatic vertebral hemangioma related to pregnancy. A case report","volume":"83","author":"Jankowski","year":"2012","unstructured":"Jankowski RNowak SKasprzyk MSymptomatic vertebral hemangioma related to pregnancy. A case report. Ginekol Pol. 2012;83(1):62-66."},{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"36","article-title":"The natural history and management of symptomatic and asymptomatic vertebral hemangiomas","volume":"78","author":"Fox","year":"1993","unstructured":"Fox MWOnofrio BM.The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg. 1993;78(1):36-45."},{"issue":"2","key":"bib2","series-title":"Neurosurgery","first-page":"287","article-title":"Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas","volume":"58","author":"Acosta","year":"2006","unstructured":"Acosta FLDowd CFChin CTihan TAmes CPWeinstein PR.Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery. 2006;58(2):287-295."},{"issue":"3","key":"bib3","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Pregnancy-related vertebral hemangioma. Case report, review of the literature, and management algorithm","volume":"19","author":"Chi","year":"2005","unstructured":"Chi JHManley GTChou D.Pregnancy-related vertebral hemangioma. Case report, review of the literature, and management algorithm. Neurosurg Focus. 2005;19(3):E7."},{"issue":"5","key":"bib4","series-title":"J Neurosurg Spine","first-page":"585","article-title":"Symptomatic vertebral hemangiomas during pregnancy","volume":"20","author":"Moles","year":"2014","unstructured":"Moles AHamel OPerret CBord ERobert RBuffenoir K.Symptomatic vertebral hemangiomas during pregnancy. J Neurosurg Spine. 2014;20(5):585-591."},{"issue":"40","key":"bib5","series-title":"Medicine (Baltimore)","first-page":"e12724","article-title":"Progression of aggressive vertebral hemangiomas during pregnancy: three case reports and literature review","volume":"97","author":"Wang","year":"2018","unstructured":"Wang BJiang LWei FLiu XGLiu ZJ.Progression of aggressive vertebral hemangiomas during pregnancy: three case reports and literature review. Medicine (Baltimore). 2018;97(40):e12724."},{"key":"bib6","series-title":"J Med Case Rep","first-page":"207","article-title":"An aggressive vertebral hemangioma in pregnancy: a case report","volume":"8","author":"Slimani","year":"2014","unstructured":"Slimani OJayi SFdili Alaoui FAn aggressive vertebral hemangioma in pregnancy: a case report. J Med Case Rep. 2014;8:207."},{"key":"bib7","series-title":"Surg Neurol Int","first-page":"105","article-title":"Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: case report and review of the literature","volume":"8","author":"Fereydonyan","year":"2017","unstructured":"Fereydonyan NTaheri MKazemi F.Recurrent symptomatic vertebral hemangioma during two consecutive pregnancies: case report and review of the literature. Surg Neurol Int. 2017;8:105."},{"issue":"8","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"888","article-title":"Vertebral arch hemangioma producing spinal cord compression in pregnancy. Diagnosis by magnetic resonance imaging","volume":"14","author":"Schwartz","year":"1989","unstructured":"Schwartz DANair SHershey BWinkelman ACFinkelstein SD.Vertebral arch hemangioma producing spinal cord compression in pregnancy. Diagnosis by magnetic resonance imaging. Spine (Phila Pa 1976). 1989;14(8):888-890."},{"issue":"suppl 2","key":"bib9","series-title":"Eur Spine J","first-page":"S299","article-title":"Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature","volume":"17","author":"Vijay","year":"2008","unstructured":"Vijay KShetty APRajasekaran S.Symptomatic vertebral hemangioma in pregnancy treated antepartum. A case report with review of literature. Eur Spine J. 2008;17(suppl 2):S299-S303."},{"issue":"6","key":"bib10","series-title":"J Spinal Disord Tech","first-page":"451","article-title":"Vertebral hemangioma symptomatic during pregnancy treated by posterior decompression, intraoperative vertebroplasty, and segmental fixation","volume":"19","author":"Inamasu","year":"2006","unstructured":"Inamasu JNichols TAGuiot BH.Vertebral hemangioma symptomatic during pregnancy treated by posterior decompression, intraoperative vertebroplasty, and segmental fixation. J Spinal Disord Tech. 2006;19(6):451-454."},{"key":"bib11","series-title":"Surg Neurol Int","first-page":"150","article-title":"Recurrent symptomatic vertebral hemangioma in pregnancy managed with decompression and vertebroplasty","volume":"12","author":"Prabhu","year":"2021","unstructured":"Prabhu RMRathod TN.Recurrent symptomatic vertebral hemangioma in pregnancy managed with decompression and vertebroplasty. Surg Neurol Int. 2021;12:150."},{"issue":"4","key":"bib12","series-title":"Radiographics","first-page":"1019","article-title":"Diagnostic imaging of solitary tumors of the spine: what to do and say","volume":"28","author":"Rodallec","year":"2008","unstructured":"Rodallec MHFeydy ALarousserie FDiagnostic imaging of solitary tumors of the spine: what to do and say. Radiographics. 2008;28(4):1019-1041."},{"issue":"5","key":"bib13","series-title":"Isr Med Assoc J","first-page":"311","article-title":"Symptomatic spinal hemangioma in pregnancy","volume":"12","author":"Blecher","year":"2010","unstructured":"Blecher RSmorgick YMirovsky Y.Symptomatic spinal hemangioma in pregnancy. Isr Med Assoc J. 2010;12(5):311-313."},{"issue":"4","key":"bib14","series-title":"Surg Neurol","first-page":"487-","article-title":"Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy","volume":"71","author":"Kiroglu","year":"2009","unstructured":"Kiroglu YBenek BYagci BCirak BTahta K.Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy. Surg Neurol. 2009;71(4):487-492."},{"issue":"2","key":"bib15","series-title":"Neurochirurgie","first-page":"166","article-title":"Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty","volume":"33","author":"Galibert","year":"1987","unstructured":"Galibert PDeramond HRosat PLe Gars D.Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33(2):166-168."},{"issue":"8","key":"bib16","series-title":"Neurol Med Chir (Tokyo)","first-page":"674","article-title":"Symptomatic T2 vertebral hemangioma in a pregnant woman treated by one stage combination surgery; posterior stabilization and anterior subtotal tumor resection. Case report","volume":"50","author":"Shinozaki","year":"2010","unstructured":"Shinozaki MMorita AKamijo KSeichi ASaito NKirino T.Symptomatic T2 vertebral hemangioma in a pregnant woman treated by one stage combination surgery; posterior stabilization and anterior subtotal tumor resection. Case report. Neurol Med Chir (Tokyo). 2010;50(8):674-677."},{"issue":"3","key":"bib17","series-title":"Eur Spine J","first-page":"244","article-title":"Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports","volume":"8","author":"Castel","year":"1999","unstructured":"Castel ELazennec JYChiras JEnkaoua ESaillant G.Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports. Eur Spine J. 1999;8(3):244-248."},{"issue":"2","key":"bib18","series-title":"J Obstet Gynaecol India","first-page":"185","article-title":"Postpartum paraparesis due to aggressive vertebral hemangioma causing spinal cord compression presenting for emergency cesarean section","volume":"69","author":"Mohanty","year":"2018","unstructured":"Mohanty CRJain MDash CBehera SS.Postpartum paraparesis due to aggressive vertebral hemangioma causing spinal cord compression presenting for emergency cesarean section. J Obstet Gynaecol India. 2018;69(2):185-187."},{"issue":"7","key":"bib19","series-title":"Oxf Med Case Rep","first-page":"122","article-title":"Aggressive vertebral hemangioma in the postpartum period: an eye-opener","volume":"2014","author":"Jain","year":"2014","unstructured":"Jain RSAgrawal RSrivastava TKumar SGupta PKKookna JC.Aggressive vertebral hemangioma in the postpartum period: an eye-opener. Oxf Med Case Rep. 2014;2014(7):122-124."},{"issue":"2","key":"bib20","series-title":"Neurosurgery","first-page":"302","article-title":"Vertebral hemangioma symptomatic during pregnancy\u2014report of a case and review of the literature","volume":"32","author":"Tekk\u00f6k","year":"1993","unstructured":"Tekk\u00f6k IHA\u00e7\u00eckg\u00f6z BSa\u011flam S\u00d6nol B.Vertebral hemangioma symptomatic during pregnancy\u2014report of a case and review of the literature. Neurosurgery. 1993;32(2):302-306."},{"key":"bib21","series-title":"Womens Health (Lond)","first-page":"17455057221099018","article-title":"Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma","volume":"18","author":"Ridzo\u0148ov\u00e1","year":"2022","unstructured":"Ridzo\u0148ov\u00e1 LFedi\u010dov\u00e1 MAndr\u00e1\u0161 TUrdz\u00edk PGdovinov\u00e1 Z.Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma. Womens Health (Lond). 2022;18:17455057221099018."},{"issue":"6","key":"bib22","series-title":"BMJ Case Rep","first-page":"e250306","article-title":"Spinal haemangioma with cauda equina syndrome in pregnancy","volume":"15","author":"Raj","year":"2022","unstructured":"Raj AAbraham ARaja Navaneethan PMathew V.Spinal haemangioma with cauda equina syndrome in pregnancy. BMJ Case Rep. 2022;15(6):e250306."},{"issue":"5","key":"bib23","series-title":"Emerg Radiol","first-page":"259","article-title":"Symptomatic vertebral hemangioma related to pregnancy","volume":"13","author":"Yuksel","year":"2007","unstructured":"Yuksel MYuksel KZTuncel DZencirci BBakaris S.Symptomatic vertebral hemangioma related to pregnancy. Emerg Radiol. 2007;13(5):259-263."},{"issue":"1","key":"bib24","series-title":"Ginekol Pol","first-page":"62","article-title":"Symptomatic vertebral hemangioma related to pregnancy. A case report","volume":"83","author":"Jankowski","year":"2012","unstructured":"Jankowski RNowak SKasprzyk MSymptomatic vertebral hemangioma related to pregnancy. A case report. 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