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Ghosn Y, Jabbour Y, Zeid FA, Jurdi N, Khouzami R, Moukaddam H. Massive spinal epidural infantile hemangioma, image findings, and treatment: a case report and review of literature. Skeletal Radiol 2024:10.1007/s00256-024-04570-1. [PMID: 38512366 DOI: 10.1007/s00256-024-04570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024]
Abstract
Spinal involvement of infantile hemangiomas is rare with the predilection to involve the epidural space. A proper diagnosis might be challenging due to the atypical location and variable/inconsistent use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by radiologists, pathologists, and clinicians. A proper diagnosis of epidural infantile hemangioma is key due to the different aggressiveness of the treatment options with inconstant literature regarding the best available treatment. Herein, we present a case of a massive epidural infantile hemangioma successfully treated with only beta-blocker. We discuss the clinical, MRI, CT, ultrasound, and histological features of this lesion as we review the literature with the objective of addressing some of the confusion surrounding the subject.
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Affiliation(s)
- Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Farah Abou Zeid
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Nawaf Jurdi
- Department of Pathology, American University of Beirut, Beirut, Lebanon
| | - Riad Khouzami
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon.
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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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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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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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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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Bennis A, Hafiane R, Benouhoud J, El Khaoudi A, Ibahioin K, Lakhdar A, Moussaid I, El Youssoufi S, Salmi S. Epidural cavernous haemangioma during pregnancy: a case report and a literature review. Pan Afr Med J 2019; 33:202. [PMID: 31692775 PMCID: PMC6814345 DOI: 10.11604/pamj.2019.33.202.8481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/08/2016] [Indexed: 11/17/2022] Open
Abstract
Cavernous haemangiomas are benign vascular malformations that can locate in the central nervous system. The epidural spinal location remains unusual. Pregnancy is known to be a precipitating factor. The aim of this study is to review general aspects of these lesions and specific facts about their relationship to pregnancy. A 32-year-old full-term pregnant woman is managed during early labor for a progressive spinal cord compression syndrome. After delivery, exploration by a lumbar MRI found an epidural vascular dorsal mass. Surgical exploration and histopathological examination confirmed the diagnosis of epidural cavernous haemangioma. The patient achieved complete recovery after 1 month. Spinal cavernous haemangiomas are rare malformations. Specific mechanisms seems to be involved in their growth during pregnancy. Although clinical and radiological presentation are spectacular and misleading, the prognosis is generally good, and urgent surgical treatment during pregnancy is usually not indicated.
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Affiliation(s)
- Anas Bennis
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco.,Department of Neurology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Reda Hafiane
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Jaafar Benouhoud
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Amine El Khaoudi
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Khadija Ibahioin
- Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Ihsane Moussaid
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Smaïl El Youssoufi
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Said Salmi
- Anaesthesiology unit, Department of Obstetrics and Gynaecology, Ibn Rochd University Hospital, Casablanca, Morocco
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Rare Case of Dumbbell-Shaped Spinal Cavernous Hemangioma and Literature Review. World Neurosurg 2018; 120:181-184. [DOI: 10.1016/j.wneu.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 11/18/2022]
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8
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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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9
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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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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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Gandhoke GS, Yilmaz S, Grunwaldt L, Hamilton RL, Salvetti DJ, Greene S. A case of spinal epidural venous malformation with mediastinal extension: management with combined surgery and percutaneous sclerotherapy. J Neurosurg Pediatr 2016; 17:612-7. [PMID: 26771680 DOI: 10.3171/2015.9.peds15341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While spinal epidural arteriovenous malformations, fistulas, and shunts are well reported, the presence of a venous malformation in the spinal epidural space is a rare phenomenon. Herein, the authors report the clinical presentation, imaging findings, pathological features, and the outcome of surgical and percutaneous interventional management of a mediastinal and spinal epidural venous malformation in a young woman who presented clinically with neurogenic claudication from presumed venous hypertension precipitating the formation of a syrinx. The patient underwent a C6-T5 osteoplastic laminectomy for decompression of the spinal canal and subtotal resection of the epidural venous malformation, followed by percutaneous sclerotherapy of the mediastinal and residual anterior spinal venous malformation. She developed transient loss of dorsal column sensation, which returned to baseline within 3 weeks of the surgery. A 6-month postoperative MRI study revealed complete resolution of the syrinx and the mediastinal venous malformation. Twelve months after the surgery, the patient has had resolution of all neurological symptoms with the exception of her premorbid migraine headaches. A multidisciplinary approach with partial resection and the use of percutaneous sclerotherapy for the residual malformation can be used to successfully treat a complex venous malformation.
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Affiliation(s)
| | - Sabri Yilmaz
- Interventional Radiology.,Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania
| | - Lorelei Grunwaldt
- Plastic and Reconstructive Surgery, and.,Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania
| | | | | | - Stephanie Greene
- Departments of 1 Neurological Surgery.,Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania
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12
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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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13
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Yang T, Wu L, Yang C, Xu Y. Epidural angiomatous meningioma of the thoracic spine: A case report. Oncol Lett 2015; 11:458-460. [PMID: 26870233 DOI: 10.3892/ol.2015.3869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 08/06/2015] [Indexed: 11/06/2022] Open
Abstract
Spinal epidural angiomatous meningiomas (AMs) are extremely rare lesions. Here, we report on a case of an epidural AM of the thoracic spine with chronic but severe cord compression. The patient underwent a T6-T8 laminectomy through the posterior approach. En bloc resection was achieved, and histopathological examination demonstrated an AM. Delayed paraplegia occurred 4 h postoperatively. The patient was treated with methylprednisolone, hyperbaric oxygen and rehabilitation. Gradually, over the next six months, the bilateral leg strength was improved compared with the preoperative status, and no tumor recurrence was noted. Although epidural AM is extremely rare, it should be included in the differential diagnosis of spinal epidural lesions. A definitive diagnosis is difficult based on magnetic resonance imaging alone due to the nonspecific characteristics of the tumor. Since AM is a histologically benign and highly vascularized tumor, timely gross total resection (GTR) is the most effective treatment. A good clinical outcome may be expected following GTR (Simpson grade I and II resection).
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing 100050, P.R. China
| | - Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing 100050, P.R. China
| | - Chenlong Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing 100050, P.R. China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing 100050, P.R. China
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Li TY, Xu YL, Yang J, Wang J, Wang GH. Primary spinal epidural cavernous hemangioma: clinical features and surgical outcome in 14 cases. J Neurosurg Spine 2015; 22:39-46. [PMID: 25343406 DOI: 10.3171/2014.9.spine13901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to investigate the clinical characteristics, imaging features, differential diagnosis, treatment options, and prognosis for primary spinal epidural cavernous hemangiomas. METHODS Fourteen patients with pathologically diagnosed non-vertebral origin cavernous hemangiomas who had undergone surgery at Beijing Tiantan Hospital between 2003 and 2012 were identified in the hospital's database. The patients' clinical data, imaging characteristics, surgical treatment, and postoperative follow-up were analyzed retrospectively. RESULTS There were 9 males and 5 females with an average age of 51.64 years. The primary epidural cavernous hemangiomas were located in the cervical spine (2 cases), cervicothoracic junction (2 cases), thoracic spine (8 cases), thoracolumbar junction (1 case), and lumbar spine (1 case). Hemorrhage was confirmed in 4 cases during surgery. Preoperatively 5 lesions were misdiagnosed as schwannoma, 1 was misdiagnosed as a meningioma, and 1 was misdiagnosed as an arachnoid cyst. Preoperative hemorrhages were identified in 2 cases. Three patients had recurrent cavernous hemangiomas. The initial presenting symptoms were local pain in 5 cases, radiculopathy in 6 cases, and myelopathy in 3 cases. Upon admission, 1 patient had radicular symptoms and 13 had myelopathic symptoms. The average symptom duration was 18 months. All patients underwent surgery; complete resection was achieved in 8 cases, subtotal resection in 4 cases, and partial resection in 2 cases. Postoperative follow-up was completed in 10 cases (average follow-up 34 months); 1 patient died, 5 patients showed clinical improvement, and 4 patients remained neurologically unchanged. CONCLUSIONS Total surgical removal of spine epidural cavernous hemangiomas with a chronic course is the optimum treatment and carries a good prognosis. Secondary surgery for recurrent epidural cavernous hemangioma is technically more challenging. In patients with profound myelopathy from acute hemorrhage, even prompt surgical decompression can rarely reverse all symptoms.
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Affiliation(s)
- Teng-Yu Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
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15
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Clinical and radiological presentation of spinal epidural haemangiomas: clinical series in a tertiary care centre during a 10-year period. 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 2013; 23:404-10. [PMID: 24097259 DOI: 10.1007/s00586-013-3045-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Haemangiomas are very frequent benign spinal tumours. However, pure epidural location is extremely rare. At present, only 52 cases have been reported in the literature during the last 10 years. We proposed to analyse clinical and radiological features of this rare entity treated in a tertiary care centre over the last 10 years. METHODS A study of a retrospective surgical series (2002-2012) was conducted. The clinic's electronic database was searched for "spinal" and/or "vertebral haemangiomas", which were treated by surgery and/or vertebroplasty. Clinical, radiological and histopathological data were analysed. RESULTS In total, the series comprised 30 spinal haemangiomas. There were 6 epidural (20 %), 17 vertebral (57 %) and 7 intradural lesions (23 %). There were four men and two women, mean age 28.3 years, with epidural lesions. One patient presented with localised back pain only, two with radiculopathy and focal neurological deficit, two with radiculopathy only and one with isolated focal neurological deficit, respectively. The onset of symptoms was progressive in four cases over weeks to months and sudden in two cases. Preoperative MRI imaging revealed features of meningioma, neurinoma or metastasis. CONCLUSION Epidural haemangiomas are extremely rare spinal lesions. They may mimic more common spinal tumours clinically and radiologically. The usual treatment is gross total resection confirming the diagnosis histologically.
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16
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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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17
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Khalatbari MR, Abbassioun K, Amirjmshidi A. Solitary spinal epidural cavernous angioma: report of nine surgically treated cases and review of the literature. 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 2012; 22:542-7. [PMID: 23053760 DOI: 10.1007/s00586-012-2526-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/10/2012] [Accepted: 09/23/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We intend to report the largest series of spinal epidural cavernomas (SEC), discuss their clinical features, imaging characteristics, surgical findings, outcome analysis and compare them with similar reports in the literature. METHODS Among the cases of spinal tumors treated surgically by the authors, there have been nine cases of SEC's. All the data were collected prospectively and the cases have been followed after surgery up to the time of this analysis. RESULTS There were six female and three male patients with the ages ranging between 13 and 74 years. The lesions were located in the thoracic spine (4 cases), lumbar spine (4 cases) and one at the sacral level. Clinical presentations included acute spinal pain and paraparesis in two, low back pain and radiculopathy in five, and slowly progressive myelopathy in the other two cases. The lesion was iso-intense with the spinal cord in T1W images and hyperintense in T2W images and showed strong homogeneous enhancement after contrast medium injection in most of our cases. In the presence of hemorrhage inside the lesion, it was hyperintense in both T1W and T2W MR sequences as in our case 6. In the single case presenting with acute hemorrhage, epidural hematoma was the only finding, our case 1. Complete surgical removal was achieved in all our cases, and confirmed by postoperative MRI. CONCLUSION SEC is hard to be differentiated from other epidural spinal lesions before intervention but should be considered in the list of differential diagnosis regarding its favorable outcome.
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Thoracic spinal epidural cavernous haemangioma with an acute onset: case report and the review of the literature. Clin Neurol Neurosurg 2012; 115:799-801. [PMID: 22918065 DOI: 10.1016/j.clineuro.2012.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 05/20/2012] [Accepted: 07/15/2012] [Indexed: 11/23/2022]
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Oppenlander ME, Kalani MYS, Dickman CA. Spinal and paraspinal giant cervical cavernous malformation with postpartum presentation. J Neurosurg Spine 2012; 16:447-51. [PMID: 22360563 DOI: 10.3171/2012.1.spine11630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cavernous malformations (CMs) are found throughout the CNS but are relatively uncommon in the spine. In this report, the authors describe a giant CM with the imaging appearance of an aggressive, invasive, expansive tumor in the cervical spine. The intradural extramedullary portion of the tumor originated from a cervical nerve root; histologically, the lesion was identified as an intraneural CM. Most of the tumor extended into the paraspinal tissues. The tumor was also epidural, intraosseous, and osteolytic and had completely encased cervical nerve roots, peripheral nerves, branches of the brachial plexus, and the vertebral artery on the right side. It became symptomatic during the puerperal period. Gross-total resection was achieved using staged operative procedures, complex dural reconstruction, spinal fixation, and fusion. Clinical, radiographic, and histological details, as well as a discussion of the relevant literature, are provided.
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Affiliation(s)
- Mark E Oppenlander
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Epidural capillary hemangioma of the thoracic spine with proximal nerve root involvement and extraforaminal extension. Acta Neurochir (Wien) 2011; 153:2279-81. [PMID: 21822781 DOI: 10.1007/s00701-011-1121-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/27/2011] [Indexed: 10/17/2022]
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Sanghvi D, Munshi M, Kulkarni B, Kumar A. Dorsal spinal epidural cavernous hemangioma. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2011; 1:122-5. [PMID: 21572634 PMCID: PMC3075829 DOI: 10.4103/0974-8237.77677] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.
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Affiliation(s)
- Darshana Sanghvi
- Department of Radiology, Pathology and Neurosurgery, Kokilaben Dhirubhai Ambani Hospital, Andheri West, Mumbai, Maharashtra, India
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