Direct intralesional n-butyl-cyanoacrylate embolization for intractable vertebral hemangioma bleeding: a salvage technique. Illustrative case

BACKGROUND: Surgical resection of vertebral hemangiomas in the setting of cord compression can be technically difficult and has the potential for life-threatening hemorrhage. The authors report a case of intraoperative direct intralesional n-butyl-cyanoacrylate embolization for intractable vertebral hemangioma bleeding. OBSERVATIONS: A 53-year-old woman presented for repeat surgery of a residual vertebral hemangioma after a previous debulking, laminectomy, and fixation that were without problems with bleeding. The second surgery was complicated by intractable hemorrhage. Bleeding was controlled with direct intralesional n-butyl-cyanoacrylate embolization after fluoroscopy without accompanying endovascular embolization. LESSONS: Aggressive vertebral hemangiomas should ideally be managed in centers where transarterial embolization is available. If such centers are not available or there is still intractable intraoperative bleeding despite preoperative embolization, direct intralesional embolization may be considered as a potential salvage technique.