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Muacevic A, Adler JR, Wichmann W, Magagna-Poveda A, Fandino J. Lumbar Epidural Cavernous Hemangioma: A Case Report and Review of the Literature. Cureus 2023; 15:e33677. [PMID: 36788892 PMCID: PMC9918856 DOI: 10.7759/cureus.33677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Pure epidural cavernous hemangioma (ECH) of the spine are rare and account for only 4% of all epidural spinal lesions. We report a case of epidural cavernoma at L3/4 presenting with L4 radiculopathy. Radiological, intraoperative findings and histopathology are presented. We present the case of a 56-year-old man who was admitted with a right L4 radiculopathy including an M4 paresis of the right leg, hypoesthesia L4, and radicular pain. Magnetic resonance imaging (MRI) confirmed an extradural lesion L3/4 partially expanding into the right intervertebral foramen. The lesion had a heterogeneous signal, isointense on T1-weighted and hyperintense on proton density (PD) and T2-weighted images. At surgery, an epidural, ovoid, gray-red, soft mass, lightly adherent to the dura and extending to the right L4 foramen was observed. Findings in the histological examination indicated a cavernous hemangioma without signs of hemorrhage. Symptoms and paresis improved rapidly after surgery. The follow-up MRI showed complete resection of the lesion with no signs of radicular compression. Spinal ECH should be considered as a cause of chronic lumbar radiculopathy with atypical radiological findings. Early diagnosis and total removal of the spinal ECH might prevent hemorrhage and neurological deficits. Fewer than 50 cases of lumbar epidural spinal hemangioma have been reported until today, and our case report is adding valuable knowledge to the existing literature.
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Pure extraosseous spinal epidural cavernous hemangioma presenting with acute paraplegia: a case report. Spinal Cord Ser Cases 2022; 8:63. [DOI: 10.1038/s41394-022-00531-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/08/2022] Open
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ÖZGER Ö, KAPLAN N, ŞENTÜRK AT. Saf torasik spinal epidural kavernöz hemanjiom (SEKH). CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1125924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Kavernöz hemanjiyomlar (KH) tüm kafa içi yapılarda, özellikle beyin parankiminde bulunabilir. Spinal hemanjiyomların çoğu vertebral kökenlidir. Omurları tutmayan spinal kavernöz hemanjiyomlara "saf" tipler denir. Saf spinal epidural kavernöz hemanjiyomlar (SEKH'lar) çok nadirdir ve tüm epidural lezyonların yaklaşık %4'ünü oluşturur. Burada son 2 aydır T8 duyu dermatomunun altında ilerleyici paraparezi ve duyu kaybı olan 42 yaşındaki kadın hastada saptanan saf torasik SEKH olgusu sunulmaktadır. Spinal epidural tümörlerin ayırıcı tanısında seçenekler arasında kavernöz hemanjiom unutulmamalıdır.
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Scafa AK, Giugliano M, Gallo M, Piccirilli M. Extradural hemorrhagic spinal cavernous angioma in a paucisymptomatic child: A rare case with review of the current literature. Surg Neurol Int 2022; 13:123. [PMID: 35509591 PMCID: PMC9062949 DOI: 10.25259/sni_997_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Cavernous angiomas, also referred to as cavernous hemangiomas or cavernomas (CMs), are vascular malformative benign neoplasms that may develop in any part of the central nervous system. Spinal CMs are uncommon (overall incidence rate of 0.04–0.05%). Pure epidural CMs account for 1–2% of all spinal CMs and 4% of all spinal epidural tumors. Diagnosis is extremely rare in the pediatric age. To the best of our knowledge, only 10 cases have been described so far. The treatment of choice is microsurgical resection. Case Description: We describe here the rare case of a cervicothoracic hemorrhagic spinal epidural cavernoma in a paucisymptomatic, 8-year-old female Bangladeshi child. C7–T2 laminectomy with excision of a scarcely defined, capsulated dark red lesion was performed with good recovery. Conclusion: Spinal epidural cavernomas are rare. Childhood presentation is even rarer. The reason could be found in a greater “compliance” and to a rarer occurrence of acute bleeding in children, thus resulting in a delayed diagnosis. Surgical excision is the gold standard of treatment.
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5
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A series of 14 representative presentations of cerebral cavernous malformations. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Caruso R, Martines V, Marrocco L, Piccione E, Wierzbicki V, Lombardi M. Case report: An epidural cavernous hemangioma mimicking a dumbbell-shaped neuroma. Int J Surg Case Rep 2021; 84:106069. [PMID: 34119941 PMCID: PMC8209077 DOI: 10.1016/j.ijscr.2021.106069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Spinal epidural cavernous hemangiomas are a rare occurrence. This particular case is made even more distinctive by the fact that the lesion mimicked a dumbbell-shaped neuroma. Moreover, it had a very unique localization (wholly epidural, at cervical-thoracic -C7-D1- level). The importance of this case is linked not only to its remarkable rarity, but also to the diagnostic avenues explored. The surgery was carried out by Prof. Riccardo Caruso, Head of the Neurosurgical Department of the Military Hospital of Rome and Professor of Neurosurgery of Sapienza University of Rome, assisted by Dr. Luigi Marrocco, Senior Neurosurgeon of the Military Hospital of Rome. Postsurgical recovery was managed by Dr. Venceslao Wierzbicki, Senior Neurosurgeon of the Military Hospital of Rome. Case presentation In 2020, a 71 year-old man, suffering from intense pain in the left scapular region and in the ulnar area of the left forearm, underwent surgery for the removal of a spinal epidural cavernous hemangioma involving the left C7-D1 foramen. Prior to surgery, the lesion had been misdiagnosed as a neuroma by a radiologist. Clinical discussion In the Literature there are other, rare cases of hemangiomas partly located in the spinal canal, and partly located intra and extra foramen. In the case here presented, differential diagnosis as well as a potential Schwannoma, suggested by the dumbbell shape of the lesion, should have considered also the possibility of a meningioma. Two teams of radiologists examined the images, the radiologists of our team, Dr. Valentina Martines and Dr. Emanuele Piccione, thanks to a close inspection of the features of the lesion, postulated the extra-dural position. Other aspects of the scans were then analyzed to help guide future diagnosis of similar lesions. Conclusion With a spinal tumor affecting the foramen, a close examination of the images allows for accurate presurgical differential diagnosis, differentiating between the more frequent neuroma and other rarer tumors, such as a hemangioma. Close examination of images is key to an accurate pre-surgical differential diagnosis for spinal tumors. A very rare spinal hemangioma mimicked in shape a dumbbell-shaped neuroma Considerations to be made when facing spinal lesions How to tell apart a neuroma, a meningioma, and a hemangioma of the spine from scans Rare case of spinal hemangioma in unique localization and presenting remarkable features
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Affiliation(s)
- Riccardo Caruso
- Sapienza University of Rome, Department of Human Neuroscience, Viale dell 'Università 30, 00185 Roma, Italy; Army Hospital of Rome "Celio", Neurosurgery Department, Via S. Stefano Rotondo n. 4, 00184 Roma, Italy.
| | - Valentina Martines
- Sapienza University of Rome, Department of Human Neuroscience, Viale dell 'Università 30, 00185 Roma, Italy
| | - Luigi Marrocco
- Army Hospital of Rome "Celio", Neurosurgery Department, Via S. Stefano Rotondo n. 4, 00184 Roma, Italy
| | - Emanuele Piccione
- Army Hospital of Rome "Celio", Neurosurgery Department, Via S. Stefano Rotondo n. 4, 00184 Roma, Italy
| | - Venceslao Wierzbicki
- Army Hospital of Rome "Celio", Neurosurgery Department, Via S. Stefano Rotondo n. 4, 00184 Roma, Italy
| | - Mariangela Lombardi
- Army Hospital of Rome "Celio", Clinical Pathology Department, Via S. Stefano Rotondo n. 4, 00184 Roma, Italy
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7
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Joshi GK, Krishna KN, Krishna DG, Murthy GK, Herur A, Karnam SV. Dorsal Spinal Epidural Cavernous Angioma; A Case Report. Asian J Neurosurg 2021; 16:144-149. [PMID: 34211883 PMCID: PMC8202371 DOI: 10.4103/ajns.ajns_150_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/23/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal cavernous angiomas are lesions formed by vessels lined by closely clustered endothelial cells. They are common in the vertebral body and less common in an intradural location. However, these are very rare in the extra-osseous and epidural region. Less than 100 cases have been reported. Here, we report a case of dorsal spinal extradural cavernous angioma in a 52-year-old man who presented with back pain and difficulty in walking. Magnetic resonance imaging brain showed D7-D8 (thoracic) extradural spinal lesion, enhancing homogeneously on contrast administration. He underwent D7-D8 hemilaminectomy and tumor decompression. The tumor was extradural, tightly adherent to the dura, and highly vascular. He recovered completely after surgical removal with no recurrence 2 years after removal. He was not administered adjuvant radiotherapy. In this article, we review the literature regarding clinical features, imaging findings, and outcome of spinal epidural cavernous angioma.
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Affiliation(s)
- Girish Krishna Joshi
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - K N Krishna
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Dilip Gopal Krishna
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Ganesh K Murthy
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Ajay Herur
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Sundeep V Karnam
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
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8
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Zhao L, Jiang Y, Wang Y, Bai Y, Sun Y, Li Y. Spinal Epidural Cavernous Hemangiomas: A Clinical Series of 9 Cases and Literature Review. Front Oncol 2021; 11:572313. [PMID: 33816222 PMCID: PMC8010302 DOI: 10.3389/fonc.2021.572313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Spinal epidural cavernous hemangiomas are very rare vascular lesions and are, therefore, seldom reported and easily misdiagnosed. Herein, we present a series of 9 cases with spinal epidural cavernous hemangiomas and discuss their pathogenesis, clinical characteristics, radiological findings, differential diagnosis, surgical interventions, pathological characteristics, and prognosis. Methods We retrospectively retrieved and analyzed the data of patients with pure epidural cavernous hemangiomas, who underwent spinal magnetic resonance imaging, and surgical intervention at the First Hospital of Jilin University, China, between January 2005 and December 2019. The data on patients’ clinical manifestations, imaging characteristics, surgical intervention, histopathological findings, and postoperative follow-up were also recorded and analyzed. Results In all, 5 men and 4 women with the mean age of 61 years (range, 41–78 years) were recruited. All patients experienced a gradual onset of symptoms and a slowly progressive clinical course, and no patient presented an acute onset of symptoms. The clinical manifestations include myelopathic signs in 8 patients (88.9%) and radicular symptoms in 3 patients (33.3%). On T1-weighted imaging, 6 lesions appeared isointense (55.6%), and 4 lesions exhibited hypointense (44.4%) signals. On T2-weighted imaging, 8 lesions appeared hyperintense (88.9%), and 1 lesion was heterogeneously intense (11.1%). Following gadolinium administration, 5 lesions appeared homogeneous with significant enhancement (55.6%), 1 lesion was homogeneous and mild enhancement (11.1%), and 3 lesions were heterogeneous with mild enhancement (33.3%). All patients received early microsurgery assisted by intraoperative electrophysiologic monitoring and neuronavigation in the lateral position via the posterior midline approach. Five patients underwent total laminectomy (55.6%), and 4 underwent hemilaminectomy (44.4%). Total excision was achieved in all cases. The average follow-up period was 55.1 months (ranging 10–123 months). All patients exhibited significant clinical improvement of their neurological deficits and achieved a favorable outcome with no recorded recurrence at last follow-up. Conclusions Spinal epidural cavernous hemangiomas are rare vascular malformations. Early surgical treatment with total resection is an optimum treatment, particularly for patients with an acute exacerbation onset. The prognosis is mostly good and depends predominantly on the severity of the preoperative status.
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Affiliation(s)
- Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yang Bai
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Ying Sun
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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9
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Zhang L, Qiao G, Shang A, Yu X. Clinical features and long-term surgical outcomes of pure spinal epidural cavernous hemangioma-report of 23 cases. Acta Neurochir (Wien) 2020; 162:2915-2921. [PMID: 32447564 DOI: 10.1007/s00701-020-04358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pure spinal epidural cavernous malformation (CM) is a rare hypervascular disease that is easily misinterpreted as other imaging-similar epidural lesions. The demographic characteristics, therapeutic strategies, and surgical outcomes associated with this vascular entity remains unclear. METHODS A retrospective review of patients with pathologically proven, pure epidural CM from 2001 to 2018 was conducted. All data that included clinical manifestations, radiographic features, and treatment modalities were analyzed. RESULTS Twenty-three consecutive patients with an average age of 51.5 ± 8.4 years old (range 38-70 years old) were included; of these, 52.2% were female patients. Clinical manifestation included chronic progressive nerve root disturbance syndrome in 7 patients (30.4%) and myelopathy in 16 patients (69.6%). The CM level was predominately thoracic (n = 14, 60.9%) or lumbar (n = 6, 26.1%), with the dorsal epidural space (n = 14, 60.9%) the most common site. The initial clinical diagnoses were schwannoma (n = 11, 52.2%), meningioma (n = 5, 21.7%), angioma (n = 3, 13.1%), recurrent CMs (n = 2, 8.7%), and metastatic tumor (n = 1, 4.3%). Fifteen lesions (65.2%) were isointense on T1-weighted images, and all lesions were hyperintense on T2-weighted images, with homogenously strong enhancement observed in 17 lesions (73.9%). Total resection was achieved in 18 patients (78.3%) and usually resulted in excellent clinical outcomes (n = 21, 91.3%). No patients experienced recurrence of symptoms, and lesion relapse during follow-up. CONCLUSION Total surgical removal of epidural CM can usually achieve satisfactory outcomes in patients with a chronic clinical course and should be recommended. Subtotal removal of tumors can also benefit patients, and guaranteed a long recurrent free time after surgery. A good preoperative neurological condition usually leads to good outcomes.
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Yotsuya K, Hasegawa T, Yamato Y, Yoshida G, Kobayashi S, Yasuda T, Banno T, Arima H, Oe S, Mihara Y, Ushirozako H, Matsuyama Y. Epidural Hemangioma: A Clinical Series of Five Patients and Review of Literature for the Decade. Spine Surg Relat Res 2020; 5:133-143. [PMID: 34179548 PMCID: PMC8208943 DOI: 10.22603/ssrr.2020-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background Since 1929, only 171 epidural hemangioma cases have been reported. We report five epidural hemangiomas and review cases reported over the past decade in terms of radiological features and clinical findings. Methods Among patients operated on for spinal tumors at our hospital between 2009 and 2020, five had epidural hemangiomas. We retrospectively examined patient records and images and reviewed relevant English literature in PubMed from 2009 to 2019. Eighty-seven epidural hemangioma cases were reported in the last 10 years. Results Among 87 cases, the average age was 49.58 years; 43 and 44 cases were male and female, respectively. The most common lesion level was thoracic (59.8%), while common symptoms were back pain (42.5%); numbness, hypoesthesia, or anesthesia (37.9%); paraparesis (34.5%); and radicular pain (20.7%). On magnetic resonance imaging (MRI), 77.1% showed hypo-isointensity on T1-weighted image (WI), hyperintensity on T2WI, and homogenous enhanced patterns with contrast. Total resection was performed in most cases, with good clinical outcomes. Preoperative embolization was performed in four cases, with good surgical outcomes. The median follow-up duration of postoperative MRI was 16 months, and no case had recurrence. Conclusions Epidural hemangiomas are extremely rare and may be difficult to diagnose preoperatively. They should be considered if a dumbbell-shaped or epidural hypervascular lesion is noted. The treatment of choice for epidural hemangioma is total resection, with most cases having good clinical outcomes. Preoperative embolization may be useful for reducing bleeding. Although there were almost no recurrences after resection, careful follow-up for longer periods is required.
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Affiliation(s)
- Kumiko Yotsuya
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Kobayashi
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Acute epidural hematoma due to spinal venous angioma: A case report. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Yang T, Wang F, Niu C. Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas. Oncol Lett 2018; 15:6036-6042. [PMID: 29552231 DOI: 10.3892/ol.2018.8024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/11/2018] [Indexed: 12/31/2022] Open
Abstract
The majority of spinal cavernous angiomas (CAs) originate from the vertebral bodies with or without epidural space extension. Solitary epidural CAs are rare. In the present study, we retrospectively reviewed the records of 12 patients who underwent microsurgery for solitary spinal epidural CAs. All patients had performed pre- and postoperative magnetic resonance imaging. The patients were 7 females and 5 males with the mean age of 52.1 years. Two tumors were located in the cervicothoracic spine, nine in the thoracic spine and one in the lumbar spine, respectively. Solitary epidural CAs generally exhibited isointensity on T1-weighted images and hyperintesity on T2-weighted images. Contrast-enhanced T1-weighted images showed homogeneous markedly enhancement. Gross total resection (GTR) was achieved in 11 cases, and subtotal resection (STR) was achieved in 1 case. During an average follow up of 35.9 months, neurological function was improved in 11 patients and in one patient, preoperative status was maintained. No patient experienced tumor recurrence. These findings suggest that CAs should be considered in the differential diagnosis of spinal epidural lesions. Early surgery is advocated to prevent irreversible neurological deficits. When aggravated by a large amount of acute hemorrhage, neurological deterioration is usually acute and prompt surgical decompression is the optimal choice. Because of the excessive vascularity of CAs, en bloc resection is recommended. In addition, a good clinical outcome after GTR can be expected, and the risk of long-term recurrence is low.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.,Department of Neurosurgery, Anhui Province Hospital, Hefei, Anhui 230001, P.R. China
| | - Fei Wang
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.,Department of Neurosurgery, Anhui Province Hospital, Hefei, Anhui 230001, P.R. China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230001, P.R. China.,Department of Neurosurgery, Anhui Province Hospital, Hefei, Anhui 230001, P.R. China
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Zhang L, Zhang Z, Yang W, Shang J, Jia W, Yang J, Xu Y. Spinal dumbbell-shaped epidural cavernous hemangioma (CM): report of nine surgical cases and literature review. Chin Neurosurg J 2018; 4:3. [PMID: 32922864 PMCID: PMC7393909 DOI: 10.1186/s41016-017-0107-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Spinal dumbbell-shaped epidural cavernous malformation (CM) is a rare, hypervascular entity frequently misdiagnosed for other lesions, leading to unexpected intraoperative bleeding and suboptimal resection. Our study aims to elucidate the demographics, management strategy, and outcome of this vascular disease. Methods Retrospective review of patients seen in Beijing Tiantan Hospital with symptomatic dumbbell-shaped epidural CM from 2008 to 2013. All lesions were pathologically confirmed after resection. The clinical manifestations, radiographic features, and treatment modalities of these cases were analyzed. Results We included 9 consecutive patients. Average age was 58 ± 12 years (range: 34–79 years), with 66.7% male. Locations of the CMs were: thoracic (n = 7, 77.8%), cervical (n = 1, 11.1%), and cervicothoracic junction (n = 1, 11.1%). Only one case presented with acute manifestations while others experienced chronic progressive spinal cord symptoms. The initial clinical diagnoses were: schwannoma (n = 6, 66.7%), cavernous hemangioma (CM) (n = 1, 11.1%), meningioma (n = 1, 11.1%), and angioma (n = 1, 11.1%). Total resection was achieved in six patients (66.7%), and partial resection in the other three patients (33.3%). Average intraoperative blood loss was 400 ± 300 ml (range: 100–1000 ml). During an average follow-up of 71 ± 21 months (range: 29–94 months), excellent outcome was achieved in seven cases (77.8%), one partially improved (11.1%), and one deteriorated (11.1%). No patients experienced recurrence of symptoms. Conclusions Spinal dumbbell-shaped epidural CM is a benign vascular malformation that should be differentiated from other dumbbell-shaped lesions. Accurate preoperative diagnose is challenging as no specific radiographic marker has been established. Total surgical resection should be recommended.
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Affiliation(s)
- Liang Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Zhifeng Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jifeng Shang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Wenqing Jia
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Jun Yang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Beijing, People's Republic of China
| | - Yulun Xu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Beijing, People's Republic of China
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14
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Sun I, Pamir MN. Spinal Cavernomas: Outcome of Surgically Treated 10 Patients. Front Neurol 2017; 8:672. [PMID: 29326642 PMCID: PMC5742471 DOI: 10.3389/fneur.2017.00672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Aim We report the preoperative and postoperative findings and also neurological follow-up results from 10 spinal cavernoma patients treated in our clinic. Several representative cases are presented in terms of clinical features, imaging results, and surgical outcomes. Material and methods The data were retrospectively collected from patients' files in the hospital records and sorted with regards to clinical presentation, radiologic features, and operative findings. Patients received spinal MRI scans for the diagnosis of spinal cavernomas (SC) and postsurgical evaluation. Clinical presentation was evaluated via Ogilvy classification and symptoms were checked preoperatively and postoperatively at third month and first year using McCormick scale. Primary treatment was microsurgical operation aiming a gross total lesion resection. Results 10 spinal cavernoma patients between the ages 30 and 63 were treated. Six (60%) of the patients were diagnosed with cervical and four (40%) others were diagnosed with thoracic SC. Among the patient group, mean preoperative Ogilvy classification score was 2.3 ± 0.7.8 and McCormick score was 1.9 ± 0.7. There was no residual mass or relapse after surgery. One patient developed surgery-related left hemiparesis, which was normalized at 1 year follow-up. Conclusion Patients must be diagnosed with MRI since it is nowadays a gold standard. Preoperative and postoperative scores are important in evaluating the patients' condition and improvement. The results from our patient series also reinforce the notion that immediate surgery should be the preferred treatment method for cavernomas. Intraoperative neurophysiologic monitarization should assist the surgery in order to prevent complications. In conclusion, microsurgery is a gold standard method that we recommend for cases of cavernomas, which will not recur if gross total resection is achieved.
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Affiliation(s)
- Ibrahim Sun
- Neurosurgery, Acıbadem University, Istanbul, Turkey
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15
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Iacob G, Rotund B, Iancu A, Madalan A, Marinescu A, Simion G. Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report. ROMANIAN NEUROSURGERY 2017. [DOI: 10.1515/romneu-2017-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
A very rare, purely intradural, spinal, extramedullary cavernous hemangioma was fortunately discovered in a 56 years old woman, presenting with bilateral brachial paresthesia. Using conventional spin-echo T1 proton density, T2-weighted magnetic resonance and gadolinium images an intradural spinal T4-T5, an extramedullary cavernous hemangioma was discovered. The patient underwent surgery, with laminectomy and microsurgical resection followed by an uneventful postoperative clinical course. Similar as in cerebral locations a mixed signal intensity in all sequences on magnetic resonance images might be indicative of cavernous hemangioma, rendering a presumptive preoperative diagnosis of the lesion and surgical planning for a good microsurgical resection.
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Oliveira E, Lavrador JP, Teixeira J, Pignatelli A, Livraghi S. A purely extradural lumbar nerve root cavernoma mimicking acute myeloid leukemia recurrence: Case report and literature review. Surg Neurol Int 2016; 7:S908-S910. [PMID: 28028446 PMCID: PMC5159694 DOI: 10.4103/2152-7806.194517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/23/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is a malignant tumor that usually occurs concomitantly with or following acute myeloid leukemia (AML). Cavernomas are benign congenital malformations that are unusual in the spine and exceedingly rare in pure extradural locations. CASE DESCRIPTION We report a 73-year-old female with a previous medical history of AML in remission for 3 years who presented with symptoms of low back pain and right lower extremity radiculopathy. A magnetic resonance scan showed an extradural, foraminal lesion centered at the L2 level involving the right L2 nerve root. In view of the history of AML, this lesion was potentially considered MS, a form of AML relapse. Surgery consisting of a right L1 and L2 hemilaminectomy facilitated gross total resection of the purely extradural lesion the proved histologically to be a cavernoma. CONCLUSION In patients with a history of leukemia, MS must be considered in the differential diagnosis for any epidural or nerve root lesion that appears following treatment. Although rare, cavernomas must be considered among the differential diagnoses for epidural nerve root lesions in the setting of AML.
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Affiliation(s)
- Edson Oliveira
- Department of Neurosurgery, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Pedro Lavrador
- Department of Neurosurgery, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Joaquim Teixeira
- Department of Neurosurgery, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - Sérgio Livraghi
- Department of Neurosurgery, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Baldvinsdóttir B, Erlingsdóttir G, Kjartansson Ó, Ólafsson IH. Extramedullary Cavernous Hemangioma with Intradural and Extradural Growth and Clinical Symptoms of Brown-Séquard Syndrome: Case Report and Review of the Literature. World Neurosurg 2016; 98:881.e5-881.e8. [PMID: 27867117 DOI: 10.1016/j.wneu.2016.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Primary spinal tumors are rare. Symptoms depend on the size and location of the tumor. CASE DESCRIPTION A patient presented with a rare clinical finding, Brown-Séquard syndrome. The symptoms were caused by an extramedullary tumor compressing on the thoracic spinal cord. Pathologic examination showed cavernous hemangioma with growth both intradurally and extradurally. CONCLUSIONS This is an extremely rare finding; to our knowledge, only 1 case report has been published before in which a spinal cavernous hemangioma had intradural and extradural growth. The clinical symptoms of Brown-Séquard syndrome have not been described before in the findings of spinal cavernous hemangiomas.
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Affiliation(s)
| | - Gígja Erlingsdóttir
- Department of Pathology, Landspítali University Hospital, Reykjavík, Iceland
| | - Ólafur Kjartansson
- Department of Radiology, Landspítali University Hospital, Reykjavík, Iceland
| | - Ingvar Hákon Ólafsson
- Department of Neurosurgery, Landspítali University Hospital, Reykjavík, Iceland; Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Esene IN, Ashour AM, Marvin E, Nosseir M, Fayed ZY, Seoud K, El Bahy K. Pure spinal epidural cavernous hemangioma: A case series of seven cases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:176-83. [PMID: 27630480 PMCID: PMC4994150 DOI: 10.4103/0974-8237.188419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pure spinal epidural cavernous hemangiomas (PSECHs) are rare vascular lesions with about 100 cases reported. Herein, we present a case series of 7 PSECHs discussing their clinical presentation, radiological characteristics, surgical technique and intraoperative findings, pathological features, and functional outcome. MATERIALS AND METHODS We retrieved from the retrolective databases of the senior authors, patients with pathologically confirmed PSECH operated between January 2002 and November 2015. From their medical records, the patients' sociodemographic, clinical, radiological, surgical, and histopathological data were retrieved and analyzed. RESULTS The mean age of the seven cases was 50.3 years. Four were females. All the five cases (71.4%) in the thoracic spine had myelopathy and the 2 (28.6%) lumbar cases had sciatica. Local pain was present in all the cases. All the lesions were isointense on T1-weighted images, hyperintense on T2-weighted images, and in five cases there was strong homogeneous enhancement. In six cases (85.7%), classical laminectomy was done; lesions resected in one piece in five cases. Total excision was achieved in all the cases. Lesions were thin-walled dilated blood vessels, lined with endothelium, and engorged with blood and with scanty loose fibrous stroma. The median follow-up was 12 months (range: 1-144 months). All patients gradually improved neurologically and achieved a good outcome with no recurrence at the last follow-up. CONCLUSION PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.
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Affiliation(s)
| | - Ahmed M Ashour
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt; Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA
| | - Eric Marvin
- Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA
| | - Mohamed Nosseir
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Zeiad Y Fayed
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled Seoud
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Khaled El Bahy
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
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Kocaman U, Ozer MH, Yilmaz MB, Yilmaz H. Thoracic Cavernoma with Intraosseous and Extradural Component Mimicking Metastasis: Case Presentation. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Spinal epidural cavernomas are quite rare lesions and only 5% of all cavernomas are located in the spine. The lesions are most commonly localized in the thoracic region. The differential diagnosis includes neurogenic tumors, lymphoma, schwannoma, meningioma, multiple myeloma, Ewing's sarcoma and metastasis. A 40- year-old male patient presented with paraplegia and MR images revealed an epidural soft tissue constricting the right posterolateral of the cord at the T6 level. Pathology showed cavernous hemangioma. A literature search revealed no other case that so closely mimicked metastasis by invading all components of the thoracic vertebra and also expanding to the epidural distance. We therefore present the case emphasizing these features.
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Amirjamshidi A, Khalatbari MR, Abbassioun K. Letter to the Editor: Primary spinal epidural cavernous hemangiomas. J Neurosurg Spine 2016; 25:141-2. [DOI: 10.3171/2015.2.spine15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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The classification of recurrent spinal epidural hematoma: a review of the literature and a comparison with the cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25 Suppl 1:224-9. [PMID: 27002614 DOI: 10.1007/s00586-016-4506-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 12/30/2022]
Abstract
Symptomatic postoperative spinal epidural hematoma (SEH) and spontaneous spinal epidural hematoma (SSEH) are both rare conditions, and recurrent SEH occurs even less frequently. Therefore, we describe a case of symptomatic postoperative SEH after surgical evacuation of SSEH, which was diagnosed using magnetic resonance imaging (MRI) and managed with negative pressure wound therapy (NPWT). The authors classified the reported recurrent SEHs into two types based on the cause of their previous hematoma, which can be classified as spontaneous or postoperative. The characteristics, diagnosis, managements, and results of recurrent SEHs were analyzed. The authors suggest that the postoperative SEH in the Type II will be treated with NPWT, and the new classification will be helpful for prognosis, diagnosis, and management of the recurrent SEHs.
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Meng Y, Shamji MF. Solitary spinal epidural cavernous haemangiomas as a rare cause of myelopathy. BMJ Case Rep 2015; 2015:bcr-2015-211644. [PMID: 26409007 DOI: 10.1136/bcr-2015-211644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cavernous haemangiomas rarely occur in the spinal epidural space. We report the case of a 27-year-old man who presented with myelopathy secondary to spinal cord compression from a purely epidural lesion. The imaging characteristics of cavernous haemangiomas are unique, reflecting a highly vascular lesion. Key differentiating features from intracranial or intramedullary lesions include the lack of a surrounding hemosiderin ring and popcorn appearance. An urgent referral to a neurosurgeon is recommended given the possibility of acute neurological deterioration from intralesional haemorrhage, and good recovery from early surgical resection. Preoperative planning with thorough patient counselling and availability of matched blood is important, and an en bloc resection approach should be taken to minimise blood loss. In this case, the patient experienced complete recovery after surgical resection. No recurrence after complete resection has been reported in the literature. This suggests a good long-term outcome for the patient and that no early adjuvant therapy is necessary.
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Affiliation(s)
- Ying Meng
- Department of Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed F Shamji
- Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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23
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Ozkal B, Yaldiz C, Yaman O, Ozdemır N, Dalbayrak S. Extraosseous, epidural cavernous hemangioma with back pain. Pol J Radiol 2015; 80:206-9. [PMID: 25960818 PMCID: PMC4410728 DOI: 10.12659/pjr.893424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 01/18/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cavernous malformations are characterized by enlarged vascular structures located in benign neural tissues within the cerebellum and spinal cord of the central nervous system. Cavernous hemangiomas (CHs) account for 5% to 12% of all spinal vascular malformations. CASE REPORT We removed a hemorrhagic thoracic mass in a 40-year-old male patient who presented with progressive neurological deficits. CONCLUSIONS We found it appropriate to present this case due to its rarity.
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Affiliation(s)
- Birol Ozkal
- Department of Neurosurgery, Alanya Goverment Hospital, Antalya, Turkey
| | - Can Yaldiz
- Departmant of Neurosurgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Onur Yaman
- Department of Neurosurgery, University of Koç, Istanbul, Turkey
| | - Nail Ozdemır
- Department of Neurosurgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Neurospinal Academy, Istanbul, Turkey
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Yaldiz C, Asil K, Ceylan D, Erdem S. Thoracic extraosseous epidural cavernous hemangioma. J Korean Neurosurg Soc 2015; 57:65-7. [PMID: 25674348 PMCID: PMC4323510 DOI: 10.3340/jkns.2015.57.1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/07/2014] [Accepted: 08/13/2014] [Indexed: 11/27/2022] Open
Abstract
Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma.
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Affiliation(s)
- Can Yaldiz
- Department of Neurosurgery, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Kiyasettin Asil
- Department of Radiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Davut Ceylan
- Department of Neurosurgery, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Sahin Erdem
- Department of Pathology, Sakarya Training and Research Hospital, Sakarya, Turkey
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Jang D, Kim C, Lee SJ, Ryu YJ, Kim J. Pure spinal epidural cavernous hemangioma with intralesional hemorrhage: a rare cause of thoracic myelopathy. KOREAN JOURNAL OF SPINE 2014; 11:85-8. [PMID: 25110490 PMCID: PMC4124926 DOI: 10.14245/kjs.2014.11.2.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/05/2014] [Accepted: 06/20/2014] [Indexed: 11/21/2022]
Abstract
Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors.
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Affiliation(s)
- Donghwan Jang
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Choonghyo Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Young-Joon Ryu
- Department of Pathology, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
| | - Jiha Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Gangwon, Korea
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Killeen T, Czaplinski A, Cesnulis E. Extradural spinal cavernous malformation: A rare but important mimic. Br J Neurosurg 2013; 28:340-6. [DOI: 10.3109/02688697.2013.841858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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27
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An unusual cause of lumbar radiculopathy. J Clin Neurosci 2013. [DOI: 10.1016/j.jocn.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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