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Our experience in 28 VH cases treated with ethanol injection indicates that it is a safe and attractive method. It preserves the trabecular support and relieves pain, although the pattern of pain relief is variable. Ethanol injection can be repeated if a complete obliteration is not achieved after the first injection (Fig. 7).

There is one report of neurologic complications after ethanol injection into a VH, which is probably due to thrombosis of the epidural veins at the level of the injection, although leakage of alcohol into the subarachnoid space cannot be ruled out (14). Authors suggested that the use of a metrizamide powder to visualize the ethanol distribution on radiographic images may prevent this type of complication. To avoid neurologic complications, both the alcohol infusion rate and the VH washout should be taken into account. It is interesting to point out that in some cases, one injection is not enough to obtain complete obliteration of the VH. In our study, only three cases had a residual hemangioma after the first injection. Two cases had a second injection, and in one case a third injection was needed to obtain a complete obliteration of the hemangioma.

TABLE 1 Clinical Findings and Results of Ethanol Injection in Four Vertebral Hemangiomas with Neurologic Symptoms

Number of ethanol

Clinical follow-up after

Age, sex, and vertebral level

Preoperative neurologic status

injections performed

ethanol injection

49-year-old man, T12

Back pain

2

Back pain improved 2 mo

after first injection

Ataxic gait, bilateral hyper-

Improvement of ataxic gait 8

reflexy of the lower limbs,

mo after the second

and normal sphincters tone,

injection

motor function, and

sensitivity

66-year-old man, T8

Mild proximal weakness of the

1 (bipedicular)

Motor deficit resolved 6 wk

lower limbs

after the injection

22-year-old man, T8

Right leg pain

1

Disappearance of the right

Bilateral T2 nerve root pain

leg level

worsened by coughing and

activity

77-year-old man, T7

Back pain 2

2

Improvement one wk after

the first injection

Paresthesias and weakness

Normal neurologic status

and slight hyper-reflexy of

3 mo after the second

the lower limbs

injection

FIGURE 7 Lumbar hemangioma treated with alcohol injection. Seven years later, the lesion was completely repaired.

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