Background: Hemangioma is the most common benign tumor of the spine. Most patients are asymptomatic, but some lesions can become aggressive, leading to spinal compression. Here, we reviewed the natural history and treatment of aggressive hemangiomas in asymptomatic patients. Methods: An electronic review of the literature was performed regarding the diagnosis/treatment modalities for asymptomatic aggressive hemangiomas of the spine utilizing the Medline (PubMed) and Google Scholar databases. Results: We selected four articles describing the diagnosis/management of four cases of aggressive, asymptomatic hemangiomas in patients averaging 11.25 ± 2.36 years of age. Three of the four patients were females, and all were followed an average of 36.5 ± 25 months. Notably, two of four patients required emergency surgery. Conclusion: There is a paucity of the literature regarding the diagnosis and optimal therapeutic management of aggressive hemangiomas in asymptomatic patients, half of whom may present with acute neurological deterioration warranting emergency surgery.

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Background: Moyamoya disease (MMD) is a rare pathology caused by a progressive unilateral or bilateral stenosis of the terminal portion of the internal carotid artery, leading to the development of collateral vessels. Case Presentation: We report a rare case of a 46-year-old male, born in the city of São Paulo, Brazil, with sudden muscular strength deficit and right hemiparesis, associated with headache and emesis. A priori, the initial diagnosis was arteriovenous malformation (AVM) after performing a series of complementary tests during the patient’s follow-up, also considering the clinical picture similar to that of Moyamoya disease (MMD). The conclusive diagnosis of MMD was finally established when the magnetic resonance imaging (MRI) showed a network of tortuous and dilated collateral vessels, with a hazy “smoke cloud” aspect with stenosis of the M1 segment of the middle cerebral artery (MCA), branch of the artery internal carotid artery (ICA). Conclusion: The recommended treatment was surgical revascularization with extracranial-intracranial bypass, with a favorable prognosis to the patient.