Successful treatment of an aggressive vertebral haemangioma with radiofrequency ablation and laminectomy: a case report.

Abstract

Background and importance: Aggressive vertebral haemangiomas are rare, hypervascular spinal tumours that can extend beyond the vertebral body, causing spinal cord compression and neurological deficits. These lesions are particularly challenging to manage due to high intraoperative bleeding risk. Although treatments like embolisation, radiotherapy, and surgical decompression have been employed, each carries limitations. Radiofrequency ablation (RFA), commonly used in metastatic spine disease, offers a targeted approach to devascularise lesions prior to surgery and may reduce perioperative morbidity.

Clinical presentation: A 17-year-old female presented with a three-week history of ascending lower limb numbness, gait ataxia, and recurrent falls. Examination revealed right lower limb weakness and sensory loss up to T5/6. MRI demonstrated an aggressive haemangioma of the T3 vertebra with extension into posterior elements and dorsal epidural compression. Given progressive symptoms, she underwent transpedicular RFA using a thermocouple-guided probe, followed by cement vertebroplasty and laminectomy (T1-T3). Intraoperatively, the posterior tumour component was unexpectedly absent, supporting the hypothesis that it collapsed following devascularisation. Neurological recovery progressed with structured physiotherapy, and no recurrence was noted on two-year follow-up imaging. Histological analysis of resected tissue confirmed a benign but clinically aggressive cavernous haemangioma, with vascular necrosis and thrombosis suggesting post-ablation changes. No malignancy was identified.

Conclusion: This case illustrates the potential of targeted RFA as an adjunctive strategy in the surgical management of aggressive vertebral haemangiomas. Preoperative devascularisation appeared to induce collapse of the posterior soft tissue component, reducing surgical complexity and minimising blood loss. This approach may enhance the safety of spinal tumour resection and optimise functional outcomes in select patients.