1
|
Spinal epidural cavernous hemangioma: Report of two cases and review of literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
2
|
Extradural lumbar nerve root and ganglion capillary hemangioma: case report. Spinal Cord Ser Cases 2021; 7:74. [PMID: 34400608 DOI: 10.1038/s41394-021-00438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Extradural spinal hemangiomas without vertebral body or intradural involvement are rare and often misdiagnosed. When present in the lumbar spine, they typically present with radiculopathy and weakness. CT imaging is helpful in assessing for bony involvement and temporal involvement while MRI imaging can be helpful in distinguishing hemangiomas from other mass lesions, however current reports on imaging features are limited. Diagnosis remains primarily dependent on tissue pathology with surgery as the mainstay of treatment. CASE PRESENTATION We present a unique case report in which we obtain additional DSA imaging to not only visualize the vascular anatomy associated with a L4-5 neuroforaminal capillary hemangioma involving the L4 nerve root and ganglion, but to also embolize the feeding artery prior to surgical resection. Patient initially underwent a CT-guided biopsy that was suspicious for a hemangioma and confirmed on final pathology to be the capillary subtype. DISCUSSION When diagnosed appropriately, patients avoid unnecessary additional testing and avoid erroneous treatment of this rare lesion. Based on our experience, we propose initial MRI imaging to characterize the hemangioma and evaluate for intradural involvement, DSA to assess vascularity followed by embolization of the lesion when able in order to minimize intra-operative hemorrhage risk, and ultimately surgery to achieve a gross total resection.
Collapse
|
3
|
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
|
4
|
Spinal Epidural Cavernous Hemangioma: A Clinical Series of 7 Patients. World Neurosurg 2018; 111:e183-e191. [DOI: 10.1016/j.wneu.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Martins MM, Francisco FAF, de Paula RA, Parente DB. Epidural cavernous hemangioma of the spine: magnetic resonance imaging findings. Radiol Bras 2015; 48:62-3. [PMID: 25798013 PMCID: PMC4366034 DOI: 10.1590/0100-3984.2013.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Chen G, Ren JG, Zhang W, Sun YF, Wang FQ, Li RF, Zhang J, Zhao YF. Disorganized vascular structures in sporadic venous malformations: a possible correlation with balancing effect between Tie2 and TGF-β. Sci Rep 2014; 4:5457. [PMID: 24966004 PMCID: PMC4071312 DOI: 10.1038/srep05457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/09/2014] [Indexed: 12/20/2022] Open
Abstract
Venous malformations (VMs) are among the most common slow-flow vascular malformations characterized by irregular venous channels, luminal thrombi, and phleboliths. To systematically manifest the disorganized vascular structures in sporadic VMs, we initially evaluated histopathological characteristics, perivascular cell coverage, adhesion molecules expression and vascular ultrastructures. Then, the expression of Tie2 and TGF-β in VMs was detected. Meanwhile, the in vitro studies were performed for mechanism investigation. Our data showed that the perivascular α-SMA+ cell coverage and expression of adhesion molecules in VMs were significantly decreased compared with those in the normal skin tissues. We also found that the expression and phosphorylation levels of Tie2 were upregulated, whereas TGF-β was downregulated in VMs, and they were negatively correlated. Moreover, the in vitro results also revealed a possible balancing effect between Tie2 and TGF-β, as demonstrated by the findings that Ang-1 (agonist of Tie2) treatment significantly downregulated TGF-β expression, and treatment with recombinant TGF-β could also suppress Tie2 expression and phosphorylation. This study provided strong evidence supporting the disorganized vascular structures and dysregulation of related molecules in sporadic VMs, and demonstrated a possible balancing effect between Tie2 and TGF-β, which might help to develop novel therapeutics for vascular disorganization-related disorders.
Collapse
Affiliation(s)
- Gang Chen
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2] Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China [3]
| | - Jian-Gang Ren
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2]
| | - Wei Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yan-Fang Sun
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2] Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feng-Qin Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Rui-Fang Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jian Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yi-Fang Zhao
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2] Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| |
Collapse
|
10
|
Sharma MS, Borkar SA, Kumar A, Sharma MC, Sharma BS, Mahapatra AK. Thoracic extraosseous, epidural, cavernous hemangioma: Case report and review of literature. J Neurosci Rural Pract 2013; 4:309-12. [PMID: 24250167 PMCID: PMC3821420 DOI: 10.4103/0976-3147.118772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 40-year-old male presented with mid-thoracic backache and progressive, ascending, spastic, paraparesis for one year. Magnetic resonance imaging demonstrated an extraosseous, extradural mass, without any bone invasion at the T2-T4 vertebral levels, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was totally excised after a T2-T4 laminectomy. Histopathological examination revealed a cavernous hemangioma. The authors reported this case and reviewed the literature, to explain why extraosseous, extradural, cavernous hemangiomas should be considered in the differential diagnosis of extradural thoracic compressive myelopathy.
Collapse
Affiliation(s)
- Manish S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi - 110 029, India
| | | | | | | | | | | |
Collapse
|
11
|
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.
Collapse
|
12
|
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]
|
13
|
A L H, T R, Chamarthy NP, Puri K. A pure epidural spinal cavernous hemangioma - with an innocuous face but a perilous behaviour!! J Clin Diagn Res 2013; 7:1434-5. [PMID: 23998084 DOI: 10.7860/jcdr/2013/6030.3159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/01/2013] [Indexed: 11/24/2022]
Abstract
Cavernous hemangiomas occur frequently in the intracranial structures but they are rare in the spine, with an incidence of 0.22 cases/million/year, which account for 5 - 12% of the spinal vascular lesions, 51% of which are extradural. Most of the epidural hemangiomas are secondary extensions from the vertebral lesions. The spinal cavernous hemangiomas which do not involve the vertebrae are referred to as "pure" types. The pure epidural hemangiomas are rare, which account for only 4% of all the epidural lesions. A case of a Pure spinal epidural cavernous hemangioma in a 50 year old male, with the clinical picture of a slowly progressive compressive myelopathy, has been presented here. The imaging studies showed a well-defined, enhancing epidural lesion at the T7 - T8 level, with dorsal cordedema and myelomalacic changes. A radiological diagnosis of a meningioma was considered. Histopathologically, the lesion was diagnosed as a hemangioma. The patient improved dramatically after the excision of the lesion.
Collapse
|