An aggressive cervical hemangioma involving the vertebral artery: a case report

Cervical hemangiomas are benign neoplastic vascular lesions composed of endothelial cell-lined vascular lumina. Although they are commonly confined to the osseous structures of the spine, in rare situations, they extend beyond their osseous borders and can compress neural elements. The pathogenesis of such masses occurs with the excessive production of growth factors by endothelial cells, thus leading to secondary bone resorption. Aggressive cervical hemangiomas can be disguised as other primary cervical masses and are therefore, a diagnostic pitfall. Such tumors often require biopsy for an accurate diagnosis. Asymptomatic masses are managed conservatively, whereas surgery is indicated in symptomatic and aggressive masses. We report a case of an aggressive cervical hemangioma that required resection with preoperative embolization of the right vertebral artery (VA).

This case report describes the successful management of a complex cervical vertebral hemangioma encasing the right VA in a 34-year-old male with chronic cervical pain and occasional occipital headaches. Imaging revealed a lobulated lesion extending from C2 to C4, centered on the right neural foramina, with scalloping of the vertebral bodies and encasement of the V2 segment of the right VA. A multidisciplinary team performed preoperative endovascular coil embolization of the right VA, followed by a single-stage anterior approach, achieving complete tumor resection with complete resolution of neck pain and intact neurological motor and sensory function postoperatively.

With multidisciplinary planning and preoperative embolization, even complex tumors involving the VA can be safely managed through a single-stage anterior approach, avoiding the need for staged surgeries.