Definition - what is a hemangioma?

Every one of us has already seen a hemangioma, also called: strawberry mark.  Parents are always worried when their just born son comes to the world with a hemangioma (usually on his face or head). In fact, this sponge can appear in several organs such as the bone tissue, the lung tissue, the kidney tissue, the liver, the pancreatic tissue (pancreas) but they can also disappear after a period of time. Hemangiomas are malformations due to an excess of tissue that proliferates in the veins, arteries, or lymphatics vessels. 

It is always possible to find a hemangioma in the vertebral bodies or in the vertebral arch during a different type of investigation. Usually affected are the thoracic and lumbar spine and statistics show that women are affected more often than men. Although such tumors are benign per se, they can become a danger. Seldom through their growth, they require space in the spine, can press on nerves and attack or destroy important structures. They rarely cause instability with the risk of vertebral fractures.

Frequency of occurrence

These proliferations of the fine blood vessels not only affect soft body regions such as the skin but also the skeleton. 40 % of all hemangiomas of the skeleton are found within the spine. The most common benign tumors of the spine, with 11%, allow hemangiomas.

What causes a hemangioma?

Hemangiomas originate when blood vessels re-build and proliferate themselves. The exact cause is unknown but genetic and hereditary factors are not excluded. Hemangiomas can arise anywhere where there are blood vessels, and then be visible to the outside, but also internally to the organs.

Symptoms

Mostly hemangiomas are asymptomatic. But when they become symptomatic there is almost a painful limited mobility in the spine where the hemangioma is. Particular attention must be paid to pressure and pain in the bones. Sensitivity disorders, bladder and rectal disorders are also possible but rare. Patients report repeatedly the so-called resting pain – that is to say in a resting position. In case of a malignant tumor symptoms are different: fever, weight loss, night sweats, lymphadenopathy and fatigue.

Diagnosis - how is a hemangioma diagnosed?

Most patients who turn to their specialist are clueless and scared. "What is growing in my body?" Is a question continually made to doctors but even the best specialist cannot answer immediately. The only thing he can do is to recommend an accurate diagnostic procedure in order to have a clear view of the situation. After a detailed anamnesis between the doctor and the patient takes place they proceed to the usual neurological examinations, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), laboratory diagnostics, possibly also nuclear medicine examination procedures and a biopsy which implies the examination of a tissue sample.

Therapy - this is how hemangiomas are treated effectively

Little and stables hemangiomas should not be treated but controlled periodically almost once a year with an MRI examination, in order to see if it grows. Usually, in order to avoid vertebral fractures, the kyphoplasty is used. If there is already an instability or tear, the affected segments will be stabilized. If the hemangioma penetrates the spinal canal, or if fragments of broken bones are already present in the spinal canal, they will be removed microsurgically.

Such an intervention may sound simple in theory, but as a matter of fact, it requires the highest surgical abilities. In the end, the spine hosts again the spinal cord and the spinal nerves- vital and extremely sensitive components of the nervous system. The removal of the hemangioma should never cause damage to the nerves because damage to the nerves is always irreparable.

Prognosis

Future expectations? The prognosis looks good! BUT: For a whole year, after the whole operation, patients should agree to specialist controls. The so-called follow-up is carried out as part of a magnetic resonance tomography and X-ray examinations.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

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Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

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