Spinal Hemangiomas are more often than not asymptomatic and incidental findings. Evidence suggests that only 1% of spinal hemangiomas become symptomatic, with 55% presenting with pain and 44% with progressive neurological compromise.
Excellent local control is achieved with aggressive intralesional resection. Percutaneous treatment, however, also plays an essential role in the treatment of hemangiomas. Multiple options have been used with varying degrees of success.
Endovascular embolization is crucial preoperatively as these tumors tend to be very vascular.
Percutaneous vertebroplasty with PMMA has relieved pain from vertebral hemangiomas with some success.
Transpedicular injection of ethanol has also been used in its management.
Lastly, radiation therapy can be considered, although controversy exists regarding the long-term consequences of radiation therapy for these benign tumors.
The picture shows an aggressive hemangioma treated with selective arterial embolization and percutaneous vertebroplasty.