Pseudomyogenic hemangioendothelioma in the thoracic spine treated with en bloc spondylectomy via staged anterior-lateral and posterior approach: illustrative case.

Background: Pseudomyogenic hemangioendothelioma (PMHE) is a rare vascular tumor with intermediate malignant potential, most commonly affecting young males and typically involving the soft tissues of the lower extremities. Spinal involvement is exceedingly rare, particularly as an isolated bony lesion without soft tissue extension, posing challenges in establishing standardized treatment approaches.

Observations: This report details a unique case of thoracic PMHE in a 60-year-old woman managed with a multistaged surgical approach, including preoperative embolization and en bloc spondylectomy. The authors describe the patient's clinical presentation, radiographic findings, surgical technique, and postoperative course, highlighting the role of en bloc resection in achieving tumor control.

Lessons: This case underscores the feasibility of aggressive surgical management for spinal PMHE and emphasizes the need for further research to refine optimal treatment strategies. https://thejns.org/doi/10.3171/CASE25256.