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Severe progressive scoliosis due to huge subcutaneous cavernous hemangioma: A case report
Yoji Ogura1, Kota Watanabe2, Naobumi Hosogane1
1Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Insights
This case study details scoliosis surgery in a young patient with a large cavernous hemangioma. It highlights the critical need for intensive hemodynamic monitoring due to significant intraoperative and postoperative hemorrhage risks.
Area of Science:
- Vascular Surgery
- Spinal Surgery
- Pediatric Orthopedics
Background:
- Cavernous hemangiomas are congenital vascular malformations that can cause scoliosis.
- Surgical treatment for scoliosis associated with cavernous hemangioma is rarely reported.
- This study addresses a unique case of severe scoliosis secondary to a large subcutaneous cavernous hemangioma.
Purpose of the Study:
- To report the surgical management of severe progressive scoliosis in a pediatric patient with a massive cavernous hemangioma.
- To emphasize the potential complications and necessary precautions during such complex surgical interventions.
Main Methods:
- A 12-year-old male with severe scoliosis (85°) and kyphosis (58°) underwent posterior correction and fusion surgery.
- Surgical intervention involved pedicle screws from T2 to L3.
- Imaging (CT and MR) revealed a large hemangioma involving subcutaneous, paraspinal, and retroperitoneal tissues, with spinal canal invasion.
Main Results:
- Posterior correction and fusion successfully reduced scoliosis to 59° and kyphosis to 45°.
- Massive hemorrhage occurred intraoperatively (2800 ml), leading to postoperative hypovolemic shock and disseminated intravascular coagulation.
- The patient developed cerebral hypoxia-induced aphasia, which resolved within two years.
Conclusions:
- Correction surgery for scoliosis associated with large cavernous hemangiomas carries a high risk of massive intraoperative and postoperative hemorrhage.
- Intensive intraoperative and postoperative hemodynamic monitoring and management are crucial for patient safety.
- This case underscores the importance of a multidisciplinary approach and vigilant care in managing complex spinal deformities linked to vascular malformations.
Abstract:
Cavernous hemangioma consists mainly of congenital vascular malformations present before birth and gradually increasing in size with skeletal growth. A small number of patients with cavernous hemangioma develop scoliosis, and surgical treatment for the scoliosis in such cases has not been reported to date. Here we report a 12-year-old male patient with severe progressive scoliosis due to a huge subcutaneous cavernous hemangioma, who underwent posterior correction and fusion surgery. Upon referral to our department, radiographs revealed a scoliosis of 85° at T6-L1 and a kyphosis of 58° at T4-T10. CT and MR images revealed a huge hemangioma extending from the subcutaneous region to the paraspinal muscles and the retroperitoneal space and invading the spinal canal. Posterior correction and fusion surgery using pedicle screws between T2 and L3 were performed. Massive hemorrhage from the hemangioma occurred during the surgery, with intraoperative blood loss reaching 2800 ml. The scoliosis was corrected to 59°, and the kyphosis to 45° after surgery. Seven hours after surgery, the patient suffered from hypovolemic shock and disseminated intravascular coagulation due to postoperative hemorrhage from the hemangioma. The patient developed sensory and conduction aphasia caused by cerebral hypoxia during the shock on the day of the surgery. At present, two years after the surgery, although the patient has completely recovered from the aphasia. This case illustrates that, in correction surgery for scoliosis due to huge subcutaneous cavernous hemangioma, intraoperative and postoperative intensive care for hemodynamics should be performed, since massive hemorrhage can occur during the postoperative period as well as the intraoperative period.