Cervicothoracic spinal epidural cavernous hemangioma: case report and review of the literature

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

“…Intradural spinal, extramedullary, cavernous hemangiomas are most frequently found in the adult population (only 4 pediatric cases cited in literature), mostly in women (23), in the thoracic spine -80% of cases (9)(12) or lower thoraco-lumbar region (13) (20), with posterior location within the spinal canal in 93% of cases; also with possible lateral recesses extensions; less common in cervical location (7)(8) and mostly adherent to the nerve root or spinal cord (8) (24). Capillary hemangiomas are found in the skin and soft tissues in younger people, and rarely occur in the central nervous system; more frequent they are located around or attached to nerve roots of cauda equina and conus medullaris (25), extremely rarely intradurally (16) 16,25) Clinical symptomatology at presentation is variable, depending on the size and topography, with the more frequent symptoms beeing: acute spinal pain, radiculopathy and/or myelopathy, progressive gait disturbance, slowly progressive paraparesis, or even asymptomatic -very rare, as in our case (5,18,(26)(27)(28). Cavernous hemangiomas may present in four major clinical patterns: acute episodes of step wise deterioration, slow progression, acute onset with rapid deterioration, and acute onset with gradual decline (10,12,14,15,18).…”

Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

“…Spinal CMs can occur along the neuraxis and are predominantly located intramedullary. However, exophytic growth and extradural CMs are reported as well [8,22]. The incidence is difficult to estimate.…”

Spinal Epidural Hemangiomas: Various Types of MR Imaging Features with Histopathologic Correlation

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] There have been several reports about MR features of a spinal epidural hemangioma. [4][5][6]8,9,[11][12][13] However, most are case reports about the cavernous type. We have found only 2 original articles that describe the MR imaging features of cavernous hemangiomas (with only 5 cases in each article).…”

“…5,8,11,[14][15][16][17][18][19] Because of the high vascularization of hemangiomas, this misinterpretation may result in unexpected intraoperative hemorrhage. Incomplete surgical removal of a spinal epidural hemangioma because of diffuse bleeding or minimal exposure during disk surgery might result in the persistence of clinical symptoms or recurrence.…”

“…Reoperation for remnant or recurrent epidural hemangioma is very difficult because of peridural or periradicular adhesion and unclear tumor margins; as a result, complete resection cannot be guaranteed in reoperation. 5,9,11 Therefore, proper preoperative planning and complete resection in the first operation is essential. For this, preoperative suspicion of epidural hemangioma is important.…”