Evidence map›Paper›PMID 40157742›Full record

ArticleJournal of neurointerventional surgery2026

Direct epidural ethanol injection in aggressive vertebral hemangiomas to decompress the central canal: a multistep percutaneous treatment strategy.

Eike Immo Piechowiak, Marco Pileggi, Maurizio Isalberti, Tomas Dobrocky, Jan Gralla, Johannes Kaesmacher, Andrea Cardia, Mario Muto, Ralph T Schär, Andreas Raabe and 2 more

Abstract read
In one paragraph

Article in Journal of neurointerventional surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Eike Immo PiechowiakDepartment of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland Eike.piechowiak@insel.ch.ORCID http://orcid.org/0000-0001-5609-0998
Marco PileggiDepartment of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland.
Maurizio IsalbertiDepartment of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland.
Tomas DobrockyDepartment of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.ORCID http://orcid.org/0000-0002-6167-3343
Jan GrallaDepartment of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.
Johannes KaesmacherDepartment of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.ORCID http://orcid.org/0000-0002-9177-2289
Andrea CardiaDepartment of Neurosurgery, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland.
Mario MutoDepartment of Neuroradiology, Antonio Cardarelli Hospital, Naples, Campania, Italy.
Ralph T SchärDepartment of Neurosurgery, Inselspital University Hospital Bern, Bern, Switzerland.
Andreas RaabeDepartment of Neurosurgery, Inselspital University Hospital Bern, Bern, Switzerland.
Giuseppe BonaldiDepartment of Neuroradiology, Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Lombardy, Italy.
Alessandro CianfoniDepartment of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVertebral hemangiomas are incidental and typically, asymptomatic lesions of the spine, present in 10-12% of the population. However, aggressive vertebral hemangiomas (AVHs) can compromise the spinal canal, leading to spinal cord or nerve root compression, and require timely treatment to prevent permanent neurological deficits. Surgical management is challenging owing to the high vascularity of AVHs, and carries a significant risk of perioperative blood loss. Intraosseous ethanol injection is commonly used for sclerotization, but may not adequately deal with epidural components.

objectiveTo carry out a staged treatment with an image-guided puncture and ethanol injection of the epidural component in 12 patients.

methodsWe retrospectively analyzed 12 patients with symptomatic AVHs who underwent targeted epidural ethanol injection followed by vertebral body cement augmentation, between 2017 and 2024, at three tertiary hospitals. Data collection included pre- and post-treatment imaging and clinical outcomes.

resultsAmong 12 patients (mean age 50, women 50%), all had extensive epidural involvement and were symptomatic, including spinal cord compression and pain. Reduction in size of more than 75% of the epidural hemangioma was achieved in 8 cases, with 11 patients experiencing complete symptom resolution. Laminectomy was performed in 3 cases, while corpectomy was avoided in all cases. Two patients had neurological worsening, with one achieving complete resolution and the other having mild residual impairment after rehabilitation due to a small spinal cord ischemic lesion. No other major complications occurred.

conclusionDirect epidural ethanol injection provides a minimally invasive alternative to surgery, such as corpectomy, including rapid size reduction of the compressive epidural component, and potentially, prevents retrograde flow into arterial collaterals. Adding vertebroplasty enhances vertebral stability.

Indexed as

Decompression, SurgicalEthanolHemangiomaSpinal Cord CompressionSpinal NeoplasmsAdultAgedFemaleHumansInjections, EpiduralMaleMiddle AgedRetrospective StudiesTreatment OutcomeEthanolCTSpineVascular Malformation

Identifiers

PMID40157742
PMCPMC12911592

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.