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Nogueira J, Sobreiro Silva J, Oliveira L, Cambango M, Ribeiro P. Cauda Equina Cavernoma: A Case Report and Literature Review. Cureus 2024; 16:e66586. [PMID: 39252750 PMCID: PMC11382809 DOI: 10.7759/cureus.66586] [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: 08/09/2024] [Indexed: 09/11/2024] Open
Abstract
Cavernous hemangiomas (or cavernomas) are benign vasculature malformations that occasionally occur in the central nervous system (CNS). The vast majority is found supratentorial, but cavernomas also appear on the spine, usually intramedullary. Cavernomas in the cauda equina are extremely rare, with only a few cases reported in the literature. We report a case of a cavernoma of the cauda equina in a 69-year-old woman with low back pain and right sciatica for two years. Lumbar MRI showed an intradural mass lesion at the L1-L2 level. She underwent surgery with resection of the lesion, which confirmed the diagnosis of cavernous hemangioma. A good clinical outcome was achieved. In addition to the case report, we present a literature review on all reported cauda equina cavernomas, discussing their clinical presentations, imaging characteristics, histological findings, and surgical management.
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Martins Coelho Junior VDP, Toop N, Kobalka P, Chakravarthy VB. Thoracic root-related intradural extramedullary cavernoma presenting with subarachnoid hemorrhage: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE2420. [PMID: 38560938 PMCID: PMC10988227 DOI: 10.3171/case2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Just 5% of all cavernomas are located in the spine. Thoracic root-related subtypes are the rarest, with a total of 14 cases reported in the literature to date. Among them, only 4 presented with subarachnoid hemorrhage (SAH). OBSERVATIONS A 65-year-old female presented after an ictus of headache with no neurological deficits. Computed tomography (CT) demonstrated sulcal SAH, with the remainder of the workup nondiagnostic for etiology. Three weeks later, she re-presented with acute thoracic back pain and thoracic myelopathy. CT and magnetic resonance imaging suggested dubiously a T9-10 disc herniation with spinal cord compression. Surgical decompression and resection were then planned. Intraoperative ultrasound (IUS) demonstrated an intradural extramedullary lesion, confirmed to be cavernoma. Complete resection was achieved, and the patient was discharged a few days postoperatively to inpatient rehabilitation. LESSONS Although spine imaging is deemed to be low yield in the evaluation of cryptogenic SAH, algorithms can be revisited even in the absence of spine-related symptoms. Surgeons can be prepared to change the initial surgical plan, especially when preoperative imaging is unclear. IUS is a powerful tool to assess the thecal sac after its exposure and to help guide this decision, as in this rare entity.
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Affiliation(s)
| | | | - Peter Kobalka
- 2Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Lumbar Spinal nerve root cavernoma: A rare cause of Intradural extramedullary lesion – Case Report. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Mastantuoni C, Pizzuti V, Ricciardi F, D’Elia A, Leonetti S, Colonnese C, Innocenzi G. Cervical spine arachnoid cyst complicated by spontaneous intracystic hemorrhage: Case report and review of the literature. Surg Neurol Int 2022; 13:427. [PMID: 36324927 PMCID: PMC9610042 DOI: 10.25259/sni_343_2022] [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: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background: Spinal intradural extramedullary arachnoid cysts represent about 1–3% of all primary spinal space-occupying lesions often causing spinal cord and/or radicular nerve compression. Spontaneous intralesional hemorrhages are extremely rare and are typically found within intracranial arachnoid cysts. Here, a 55-year-old female presented with a spontaneous hemorrhage into a cervical spine arachnoid cyst warranting surgical intervention (i.e., fenestration/excision/occlusion). Case Description: A 55-year-old female presented with 3 weeks of dull pain in the cervicothoracic region. She subsequently developed paresthesias and progressive lower extremity weakness with (urinary incontinence. The cervical magnetic resonance revealed a right anterolateral intradural extramedullary “cystic” lesion extending from C7 to T2; it contained a heterogeneous signalon T2W sequences, and a fluid-fluid level was documented on the T2-GRE and FLAIR sequences. At surgery, consisting of a laminectomy, two hemorrhagic cystic lesions were identified and removed. Histological findings were consistent with hemorrhagic into an arachnoid cyst. Conclusion: Only rarely hemorrhages develop in intraspinal intradural extramedullary spinal arachnoid cysts.
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Affiliation(s)
- Ciro Mastantuoni
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Azienda Ospedaliera Universitaria Federico II, Naples Napoli, Italy
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Frank F, Maybaum J, Frydrychowicz C, Stoll K, Gaber K, Meixensberger J. Cervical intradural extramedullary cavernous malformation as a rare cause of subarachnoid hemorrhage without spinal dysfunction: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21463. [PMID: 36130539 PMCID: PMC9379632 DOI: 10.3171/case21463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Intradural extramedullary cavernoma is a very rare lesion of the spinal cord, especially of the cervical spine. Its clinical presentation can vary with symptoms of sensory or motor deficits and even with symptoms of subarachnoid hemorrhage (SAH).
OBSERVATIONS
The authors present a case of a 45-year-old man with SAH with prolonged neck pain and increasing headache confirmed by lumbar puncture. Head computed tomography revealed only discrete blood deposits in the right frontal and biparietal lobes. The finding of pan-cerebral angiography was negative for the cause of bleeding. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion at cervical level C5–6. The finding of subsequent cervical angiography was negative. The diagnosis of a cavernous malformation was confirmed histopathologically after surgery. The cavernoma was completely removed, and full recovery of the initial symptoms was achieved.
LESSONS
Spinal lesions should be considered in the diagnostic work-up for SAH with excluded origin of bleeding in cranial neuroimaging. An intradural extramedullary cavernous malformation is an extremely rare entity in the differential diagnosis of SAH, and surgical resection is the treatment of choice to prevent further bleeding and neurological deficits.
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Affiliation(s)
| | | | | | - Kristin Stoll
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
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Guimarães Rocha MS, Grangeiro Mirô HS, Manfroi G, de Medeiros Dias A, Cardoso R, Dozzi Brucki SM. Unusual Presentation in Infratentorial Superficial Siderosis: Acute Intracranial Hypertension. Case Rep Neurol 2021; 13:9-16. [PMID: 33613238 PMCID: PMC7879318 DOI: 10.1159/000510847] [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: 07/11/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022] Open
Abstract
Superficial siderosis (SS) of the nervous system is a rare acquired condition related to hemosiderin deposits in subpial layers of the brain, brainstem, cerebellum, cranial nerves, and spinal cord, leading to brain iron-mediated neurodegeneration. The cardinal neurological features are slowly progressive hearing loss, ataxia, and pyramidal signs. Here we describe an atypical case of infratentorial SS evolving with acute intracranial hypertension in the absence of typical chronic signs.
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Affiliation(s)
- Maria Sheila Guimarães Rocha
- Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil.,Department of Internal Medicine, Faculdade Santa Marcelina, São Paulo, Brazil
| | | | - Gregori Manfroi
- Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
| | | | - Raphaella Cardoso
- Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
| | - Sonia Maria Dozzi Brucki
- Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil.,Department of Neurology, University of São Paulo, São Paulo, Brazil
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Camlar M, Karadag A, Oztekin O, Ozer F. Superficial Siderosis of the Central Nervous System Due to Recurrent Surgeries of the Thoracic Spine: A Rare Case. World Neurosurg 2018; 119:384-388. [PMID: 30165218 DOI: 10.1016/j.wneu.2018.08.140] [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: 06/26/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Superficial siderosis (SS) of the central nervous system is a rare condition caused by hemosiderin deposition in the subpial layers of the brain and spinal cord. Surgical complications are the primary factor for occurrence of secondary SS. We present a case of SS with an identified bleeding origin in the thoracic spine. CASE DESCRIPTION A 58-year-old female patient experienced 9 months of continuous progressive dizziness, difficulty with mobilization, drop attacks, and lack of hearing. The patient also had an extensive history of thoracic spinal surgeries. She came to the hospital with gait imbalance. Gradient echo (GE) magnetic resonance imaging (MRI) confirmed hemosiderin deposition along the cerebellar folia and vermis. GE sequences are preferable in this diagnosis, because of higher sensitivity, and for detecting characteristic T2 hypointensity. The dural defect was repaired with an artificial dural patch in thoracal operation area. Clinical findings, imaging studies, intraoperative findings, and literature information are presented. CONCLUSIONS Performance of an open neurosurgical procedure to repair a dural defect in the presence of MRI confirmed that superficial siderosis is an optimal method and a crucial step to ensure the safe resolution of the condition and to break the circle of emergency admissions of a patient with a dural defect and a history of multiple spinal surgeries.
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Affiliation(s)
- Mahmut Camlar
- Department of Neurosurgery, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey.
| | - Ali Karadag
- Department of Neurosurgery, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey
| | - Ozgur Oztekin
- Department of Radiology, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey
| | - Fusun Ozer
- Department of Neurosurgery, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey
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