Haemangiomas

Definition

  • haemangiomas are benign lesions characterised by vascular spaces lined with endothelial cells, 50% in spine, 20% in skull

Presentation

  • 40-50 peak incidence
  • usually asymptomatic (incidental finding)
  • neurological symptoms or back pain

Investigations

  • X-ray
    • vertebra
      • thickened vertical trabeculae secondary to erosion of horizontal trabeculae
    • skull
      • radiating wheel spoke
  • CT
    • polka dot appearance
  • MRI
    • T1 low, T2 high
  • Bone scan
    • repeat local staging at hot spots
  • Biopsy

Treatment

Non-operative

  • If asymptomatic – observe
  • Radiation
    • spine
  • Embolisation
    • either as Treatment or preop

Operative

  • Excision & bone graft
    • always preop embolisation