Cervical corpectomy for resection of ventral intramedullary capillary hemangioma with circumferential involvement of the anterior spinal artery: case report

Abstract

<jats:p>There is limited evidence to suggest that anterior approaches for the resection of ventral intramedullary lesions of the cervical spinal cord may result in superior neurological outcomes compared with those following more traditional posterior approaches. To the authors’ knowledge, no report of an anterior approach to resect a ventral intramedullary capillary hemangioma exists in the literature. In the following paper, the case of a 75-year-old male who presented with progressive neck and left shoulder pain, weakness of the left hand, myelopathy, and gait imbalance is reported. Postcontrast T1-weighted MRI demonstrated a homogeneously enhancing intramedullary lesion with associated severe impingement of the cervical spinal cord at C-4. Following a C-4 corpectomy, intradural exposure revealed a vascular lesion that circumferentially enveloped the anterior spinal artery. Gross-total resection of the lesion was performed, followed by reconstruction of the corpectomy defect, without neurological deterioration. Pathology was consistent with capillary hemangioma. In this instance, the anterior approach helped to avoid unnecessary neural manipulation and allowed for early identification of normal proximal and distal segments of the anterior spinal artery, which facilitated safe dissection and gross-total removal.</jats:p>

Intramedullary capillary hemangioma mimicking myelitis with longitudinally extensive spinal cord lesions

“…It was first reported by Hida, 2 and 14 adult cases had been reported since then (Table 1). 1‐9 Our case was similar to the reported cases in terms of age of onset, sex, and lesion location. On the other hand, MRI findings mimicking myelitis with LESCL have not been previously reported.…”

Resection of a ventral intramedullary spinal cord ependymoma through an anterior cervical approach: illustrative case

“…Although anterior resections of ventrally located cervical intramedullary tumors have been previously reported in the literature, 7–10 this report describes, to our knowledge, the first case of a cervical intramedullary ependymoma resected through an anterior approach with corpectomy and fusion.…”

“… 16 Furthermore, the large durotomy necessary for resection increases the risk of an anterior cervical cerebrospinal fluid fistula. 7 Water-tight dural closure is essential and may require the use of dural substitutes, dural sealants, and/or lumbar drainage. Moreover, the anterior approach poses additional risks to the nearby structures with possible airway edema, dysphagia, dysphonia, and damage to the anterior spinal artery.…”

“… 1 , 18 In the present case, the anterior surgical approach provided direct access to the ventral intramedullary ependymoma and did not cause any posterior column deficits. 5 , 7 , 10 , 13 Compared to ependymomas, the plane of hemangioblastomas may be more forgiving, as they typically come to the surface and have a distinctive reddish-orange appearance. 5 …”

Thoracic Intra and Extramedullary Capillary Hemangioma with Subacute Clinical Course: A Case Report and Literature Review

“…To our knowledge, only 31 cases of spinal intramedullary capillary hemangiomas have been reported (Table 1). 1,3,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21] Among them, approximately 19 cases included extramedullary and intramedullary components. Intradural capillary hemangiomas present in the fifth to sixth decades, with no sex predilection.…”