Vertebral
hemangiomas are benign lesions accounting for 2 to 3% of all spinal
tumors. They are usually asymptomatic and found incidentally on imaging. Uncommonly, vertebral
hemangiomas with significant epidural extension can result in
radiculopathy or
spinal cord compression. Decompressive surgery with or without stabilization is often required when neurological deficits are present. However, surgery can be associated with massive
hemorrhage as these
tumors are hypervascular. Preoperative embolization and
sclerotherapy are well-known management strategies used to minimize intraoperative
bleeding and improve symptoms. Recently, the use of
sclerosants such as
ethanol has decreased, due to reported complications such as
Brown-Sequard syndrome. We describe the use of
sodium tetradecyl sulfate (Fibro-Vein™, STD
Pharmaceutical, Hereford, UK) as an effective alternative to
ethanol in the preoperative management of vertebral
hemangiomas. To our knowledge, this has not been previously reported. In three patients, we demonstrated minimal intraoperative blood loss using a combination of preoperative embolization of arterial feeders and
sclerotherapy with
sodium tetradecyl sulfate to control and secure venous drainage. No patients developed complications related to the procedure. In addition to minimal blood loss, a clear dissection plane was also noted intraoperatively.