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Benevello C, Laaidi A, Peeters S, Moiraghi A, Tauziede-Espariat A, Oppenheim C, Pallud J. Spinal epidural capillary hemangioma: a systematic literature review and an illustrative case. Neurochirurgie 2022; 68:697-701. [PMID: 35477014 DOI: 10.1016/j.neuchi.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal hemangiomas are rare vascular malformations resulting from proliferation of vascular endothelial cells. The cavernous form is the most common and represents 5-12% of spinal vascular malformations, while the capillary form is rare. CASE DESCRIPTION A 56-year-old patient with no past medical history presented with progressive spinal cord compression symptoms localizing to the T10 level with MRC grade 4 proximal paraparesis. Preoperative MRI demonstrated a well-delineated, dumbbell-shaped, epidural lesion, without bony involvement, resulting in spinal cord compression at the T7 and T8 levels. The patient underwent gross total surgical resection of the lesion. At the one month follow up, the patient's strength improved to MRC grade 5, and sensation had fully returned. The histopathological diagnosis was a capillary hemangioma. Exclusively epidural capillary hemangiomas are extremely rare with only 26 cases reported in the literature. They are mainly located at the thoracic level (T4-T6). The MRI features include a well-circumscribed mass, hyperintense on T2-weighted sequence in 92% of cases, isointense on T1-weighted sequence in 88% of cases, and homogeneous contrast enhancement in 100% of cases. No tumor recurrence has been observed after gross total surgical removal. CONCLUSIONS When evaluating progressive spinal cord compression by a purely epidural spinal lesion, the differential diagnosis should include capillary hemangioma, in addition to schwannoma, meningioma, and lymphoma. Early and complete surgical removal is the first line treatment.
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Affiliation(s)
- C Benevello
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - A Laaidi
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - S Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Moiraghi
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France
| | - A Tauziede-Espariat
- Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Department of Neuropathology, GHU site Sainte-Anne, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France
| | - C Oppenheim
- Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France; Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
| | - J Pallud
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, 102-108 rue de la Santé, 75014 Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Inserm, IMA-BRAIN, Paris, France.
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Sudhir G, Jayabalan V, Manohar TH, Gadde S, Kumar V, Kailash K. Posttraumatic thoracic epidural capillary hemangioma - A rare case report. Surg Neurol Int 2020; 11:179. [PMID: 32754354 PMCID: PMC7395521 DOI: 10.25259/sni_567_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Capillary hemangiomas are benign vascular lesions commonly seen in subcutaneous tissues. The most common site of origin is from the vertebral body, and only a few cases of isolated lesions in thoracic epidural space, especially after trauma, have been reported in the literature. Case Description: We report a case of 63-year-old male with progressive bilateral lower limb weakness and exaggerated lower limb deep tendon reflexes without bowel and bladder involvement. His history revealed T7 fracture with paraparesis which was treated surgically, and implants were removed a year later. MRI showed an epidural lesion from T6-T8 extending into the right T7-8 foramen which showed hypointensity on T1, hyperintensity on T2, and homogenous enhancement in contrast images with severe cord compression. Laminectomy was done and the lesion was removed en bloc. Histopathological examination revealed it to be capillary hemangioma. The neurology came back to normal after 3 months. Conclusion: Although capillary hemangiomas are rare lesions, it has to be considered in the differential diagnosis of epidural space-occupying lesions which require early surgical removal to prevent a progressive and permanent neurological deficit.
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Affiliation(s)
- G Sudhir
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vignesh Jayabalan
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - T H Manohar
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Saikrishna Gadde
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Venkatesh Kumar
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Karthik Kailash
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Rajpal S, Johs S, Zaronias C, Forsythe RC, Burneikiene S. Spinal Epidural Capillary Hemangioma With Intrathoracic Extension: Case Report and Review of the Literature. Cureus 2020; 12:e9358. [PMID: 32850229 PMCID: PMC7444968 DOI: 10.7759/cureus.9358] [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] [Indexed: 11/05/2022] Open
Abstract
Capillary hemangiomas are hamartomatous congenital vascular malformations that are particularly uncommon in the spinal epidural space, and those with intrathoracic extensions are extremely rare. Although considered benign, capillary hemangiomas can cause rare hemorrhagic complications and risk of spinal cord compression or extension into the neural foramen. Therefore, surgery should be considered even in the absence of neurological symptoms. The literature reports three patients either underwent a partial resection or a complete tumor removal was achieved by accessing the lesion through a posterolateral approach and removing the costotransverse joint. The patient underwent a same-day, two-staged gross total resection of the tumor via combined posterior right-sided T7-T8 complete facetectomy and extradural mass resection with T7 nerve transection, followed by a posterolateral fusion of the T7-T8 vertebra. Stage 2 consisted of a video-assisted intrathoracic approach for the removal of the remaining tumor. The two-stage surgical procedure described in our case report allows for complete removal of intrathoracic and intraspinal portions of the mass with less morbidity.
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Affiliation(s)
- Sharad Rajpal
- Neurosurgery, Boulder Neurosurgical Associates, Boulder, USA
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De Paepe E, Van Hoe L, Fadaei S, Dekeyzer S. An uncommon intraspinal mass. Acta Neurol Belg 2020; 120:701-703. [PMID: 30997604 DOI: 10.1007/s13760-019-01140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
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Gupta S, Singh S, Gogoi S, Das KK, Jaiswal AK. Impetuous expansion of pure epidural capillary hemangioma in pregnancy: A rare cause of acute paraplegia. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cofano F, Marengo N, Pecoraro F, Penner F, Bertero L, Zenga F. Spinal epidural capillary hemangioma: case report and review of the literature. Br J Neurosurg 2019:1-4. [DOI: 10.1080/02688697.2018.1562034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Fabio Cofano
- Department of Neuroscience, Neurosurgery, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Nicola Marengo
- Department of Neuroscience, Neurosurgery, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Pecoraro
- Spinal Surgery, Humanitas Research Center – Humanitas Gavazzeni, Bergamo, Italy
| | - Federica Penner
- Department of Neuroscience, Neurosurgery, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Luca Bertero
- Department of Medical Sciences, Pathology Division, AOU Città della Salute e della Scienza, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience, Neurosurgery, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
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Brasil AVB, Rohrmoser RG, Gago G, Cambruzzi E. Atypical spinal epidural capillary hemangioma: Case report. Surg Neurol Int 2018; 9:198. [PMID: 30386668 PMCID: PMC6194730 DOI: 10.4103/sni.sni_90_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/16/2018] [Indexed: 11/06/2022] Open
Abstract
Background: Hemangiomas are benign vascular malformations that can involve the spine. Pure epidural hemangiomas are rare and represent only 4% of all epidural lesions. Most hemangiomas are of the cavernous type; the capillary variant is atypical, and only ten cases have been reported in the literature. Case Description: A 69-year-old female presented with nonspecific dorsal pain. Magnetic resonance imaging (MRI) showed a spinal epidural tumor at the T9-T10 level. Following a T9-T11 laminectomy, the lesion was completely resected en bloc. Histopathologic analysis showed a pure epidural capillary hemangioma with adipose tissue mesenchyma. Conclusions: Although epidural capillary hemangiomas are extremely rare, they should be considered among the differential diagnoses of extradural, extramedullary spinal lesions. Further, they must be differentiated from other more common lesions such as meningiomas and schwannomas. The recommended surgical management is en bloc gross total excision.
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Affiliation(s)
- Albert Vincent B Brasil
- Department of Neurological Surgery, São José Hospital, Santa Casa de Misericórdia de Porto Alegre Hospital Complex, Porto Alegre, Brazil
| | - Ruy Gil Rohrmoser
- Department of Neurological Surgery, São José Hospital, Santa Casa de Misericórdia de Porto Alegre Hospital Complex, Porto Alegre, Brazil
| | - Guilherme Gago
- School of Medicine, Catholic University of Pelotas, Pelotas, Brazil
| | - Eduardo Cambruzzi
- Department of Pathology, Santa Rita Hospital, Santa Casa de Misericórdia de Porto Alegre Hospital Complex, Porto Alegre, Brazil
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Abstract
Capillary hemangiomas (CAs) are benign endothelial cell neoplasms that are often encountered superficially in the soft tissues of the head and neck region. Most of the reported purely spinal epidural hemangiomas have been of cavernous type, and the occurrence of purely spinal epidural CA is exceedingly rare, and there are only 12 reported cases of spinal epidural CAs in the English literature. Herein, the authors report the 13th case of purely spinal epidural CAs, and the clinical characteristics, histopathological features, and treatment were also investigated.
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Hémangiome capillaire épidural lombosacré mimant un neurinome en sablier : à propos d’un cas et revue de la littérature. Neurochirurgie 2016; 62:113-7. [DOI: 10.1016/j.neuchi.2015.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 06/19/2015] [Accepted: 08/10/2015] [Indexed: 11/18/2022]
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Dumbbell-Shaped Epidural Capillary Hemangioma Presenting as a Lung Mass: Case Report and Review of the Literature. Spine (Phila Pa 1976) 2015; 40:E849-53. [PMID: 25946721 DOI: 10.1097/brs.0000000000000970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and literature review. OBJECTIVE We present the fourth case of a spinal epidural capillary hemangioma with a dumbbell-shaped appearance in the magnetic resonance image reported in the literature and the second presented as a lung mass. SUMMARY OF BACKGROUND DATA Hemangiomas are congenital vascular malformations that pathologists frequently consider to be hamartomatous malformations. Hemangiomas of the spine are usually lesions of the vertebral bodies, but they can sit in other locations such as the intramedullary or epidural space. Purely epidural hemangiomas are rare and most of them are of cavernous type. METHODS We present a 67-year-old female with a thoracic dumbbell-shaped capillary hemangioma with both foraminal and intrathoracic extensions, whose presentation was pleural effusion associated with mediastinal mass suggestive of pulmonary neoplasia. Surgical treatment consisted of total removal en bloc of the lesion. RESULTS Microscopic evaluation showed a fibrofatty tissue with a proliferation of vascular structures that were generally of a small size, with areas of myxoid appearance. To date, there have been 8 epidural capillary hemangiomas of the thoracic and lumbar spine reported in the literature, and only 3 of them were dumbbell-shaped with extraforaminal extension. CONCLUSION It is important to consider the diagnosis of hemangiomas in the differential diagnosis of epidural lesions with dumbbell-shaped appearance in the magnetic resonance image, especially at the thoracic level. It is a benign and potentially curable disease and the most appropriate surgical treatment is en bloc resection of the entire lesion. They are usually presented as a progressive myelopathy, so early treatment may prevent permanent neurological deficits. LEVEL OF EVIDENCE 5.
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Acute flaccid paraplegia: neurological approach, diagnostic workup, and therapeutic options. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(14)60073-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gencpinar P, Açıkbaş SC, Nur BG, Karaali K, Arslan M, Gurer EI, Duman O, Haspolat S. Epidural capillary hemangioma: A review of the literature. Clin Neurol Neurosurg 2014; 126:99-102. [PMID: 25233492 DOI: 10.1016/j.clineuro.2014.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/15/2014] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
Abstract
Hemangiomas in the spinal epidural area are very rare lesions, and most of these lesions are of the cavernous type. Only seven cases of capillary hemangiomas have been reported in the English literature, and all of these cases occurred in adulthood. Here, we report on a 17-month-old girl who presented with an inability to walk. MRI revealed an epidural mass, which was diagnosed as an epidural capillary hemangioma in the thoracic region. To our best knowledge, this case is the first epidural capillary hemangioma case to occur in childhood that has been reported.
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Affiliation(s)
- Pinar Gencpinar
- Department of Pediatric Neurology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Sabri Cem Açıkbaş
- Department of Neurosurgery, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Banu Güzel Nur
- Department of Pediatric Genetics, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Kamil Karaali
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Murat Arslan
- Department of Neurosurgery, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Elif Inanc Gurer
- Department of Pathology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Ozgur Duman
- Department of Pediatric Neurology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Senay Haspolat
- Department of Pediatric Neurology, Akdeniz University Medical Faculty, Antalya, Turkey.
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