Lumbar extradural dumbbell cavernous hemangioma: A rare lesion

Dorsal Spinal Epidural Cavernous Angioma; A Case Report

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.

Enhanced recovery after surgery in intramedullary and extramedullary spinal cord lesions: perioperative considerations and recommendations

Enhanced recovery after surgery (ERAS) is an evidence-based approach developed to ameliorate the patient recovery process following surgical procedures. Employing a multimodal, multidisciplinary approach, ERAS implements strategies and treatment paradigms that have been shown to improve patient outcomes, reduce hospital length of stay, and ultimately reduce healthcare costs. With a substantial body of the literature supporting the implementation of ERAS in other surgical specialties, ERAS has only recently made its foray into spine surgery. Despite this, current studies are limited to spinal deformity and degenerative disease, with limited data regarding spinal cord surgery. This is due in part to the complex nature and rarity of spinal cord lesions, making the establishment of a formal ERAS protocol difficult. In developing an ERAS protocol, there must be a consensus on what factors are important to consider and implement. To address this, we reviewed the most recent advances in intramedullary and extramedullary spinal cord surgery in order to identify elements that influence patient outcomes. Using this information, the authors provide evidence-based recommendations with the intent of introducing a framework for future ERAS protocols with respect to treating spinal cord lesions.

Spinal dumbbell-shaped epidural cavernous hemangioma (CM): report of nine surgical cases and literature review

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.