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Case Reports
. 2025 Sep 11:12:1647623.
doi: 10.3389/fsurg.2025.1647623. eCollection 2025.

Intravascular embolization with spinal decompression and vertebral shaping for acute cauda equina syndrome from aggressive vertebral hemangioma: a case report and literature review

Qing-Quan Chen #  1 , Hong-Shen Wang #  1 , Hui Wang #  1 , Jin-Shui Chen  1 , Jie Xiao  1 , Xiu Yang  1
Affiliations
Case Reports

Intravascular embolization with spinal decompression and vertebral shaping for acute cauda equina syndrome from aggressive vertebral hemangioma: a case report and literature review

Qing-Quan Chen et al. Front Surg. .

Abstract

Objective: To evaluate the clinical outcomes of a multidisciplinary approach for the treatment of aggressive vertebral hemangioma with acute cauda equina compression.

Case description: A 37-year-old female patient with aggressive vertebral hemangioma presented with sudden loss of muscle strength in both lower limbs (grade I-II) and difficulty in urination and defecation. Magnetic resonance imaging and digital subtraction angiography confirmed a vascular tumor within and around the L4 vertebra, causing cauda equina compression. The treatment involved staged vascular embolization (of the third lumbar artery and branches of the sacral artery) combined with L4 vertebroplasty, laminectomy decompression, and pedicle screw fixation. Postoperative pain was immediately relieved. After 3 months of rehabilitation, muscle strength in both lower limbs recovered to grade 3, with significant improvement in spontaneous urination and defecation. Imaging studies showed complete relief of spinal canal compression.

Conclusions: Aggressive spinal hemangioma may require multidisciplinary collaboration, and staged vascular embolization combined with spinal decompression and stabilization surgery can effectively improve neurological function. Early intervention is crucial for achieving favorable outcomes.

Keywords: aggressive vertebral hemangioma; embolization therapeutic; multidisciplinary approach; spinal cord compression; vertebroplasty.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preoperative imaging data of the patient. (A–D) Preoperative MRI images (E), preoperative DSA image, and (F–H) preoperative CTA image.
Figure 2
Figure 2
Postoperative imaging data of the patient. (A,B) postoperative DSA images, (C,D) postoperative x-ray anteroposterior and lateral views, (E,F) postoperative CTA images, and (G,H) postoperative MRI images.
See this image and copyright information in PMC

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