A338 Multistep percutaneous treatment of aggressive vertebral hemangiomas using direct epidural ethanol injection as an alternative to open surgery

<h3>Introduction</h3> Vertebral hemangiomas are common vascular malformations affecting 10–12% of the population, often asymptomatic but occasionally aggressive, causing spinal canal infiltration and fractures. Surgical treatment carries risks due to high vascularity and blood loss. Image-guided percutaneous methods like ethanol sclerotherapy and vertebroplasty offer minimally invasive alternatives but may not adequately address epidural components. Direct epidural ethanol injection can achieve immediate decompression. <h3>Aim of Study</h3> This study evaluates the safety and effectiveness of staged, image-guided direct epidural ethanol injection for treating aggressive vertebral hemangiomas (AVHs) with extensive epidural involvement, assessing clinical outcomes and complications. <h3>Method</h3> In this retrospective study (2017–2025), 25 AVH patients across three centers were analyzed. Fourteen patients received direct epidural ethanol injections following CT/MRI imaging. Procedures were performed under CT-guidance and general anesthesia, including intraosseous and epidural injections, followed by vertebroplasty. Outcome measures included MRI/CT evaluation of epidural size reduction and complication rates over 3–12 months. <h3>Results</h3> Of 25 patients, 14 underwent direct epidural injections (30 injections total). Patients (6 women, 8 men; mean age 50) presented with myelopathy, back pain, or neurological deficits. Two major complications occurred, both resolving without severe sequelae. Thirteen patients experienced complete symptom resolution, and most showed ≥75% reduction of the epidural component. <h3>Conclusion</h3> Direct epidural ethanol injection is a safe, effective alternative for managing AVHs with epidural involvement, offering rapid decompression and reducing the need for invasive surgery. Combined with vertebroplasty, it strengthens vertebral stability with minimal complications. <h3>Conflict of Interest</h3> No