Dorsal spinal epidural cavernous hemangioma

Abstract

A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.

Pure Spinal Epidural Cavernous Hemangioma with Intralesional Hemorrhage: A Rare Cause of Thoracic Myelopathy

“…They are most commonly located in the posterior aspect of thoracic spine as in our case3,4,6,8). It is thought to be related with several factors; the larger available epidural space3,6), the lower resistance in the posterior portion of the spinal canal6), and the abundant venous plexus in the dorsal or dorsolateral of the epidural space13).…”

Spinal epidural venous angioma presenting symtomps of lumbar disc herniation: a case report

“…Extradural spinal angiomas are most commonly observed in the dorsal and lumbar regions with solitary forms located particularly in the lower lumbar and lumbosacral regions (9). Even with angiography and MRI, the clinical diagnosis of extradural and intradural angiomas remains difficult (1, 3,4,5,10,13,14). Extradural angiomas are most often confused with disc hernias and spinal tumors (3).…”

Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas

“…Spinal angiography has no role in diagnosis as CAs have no communication with the spinal arteries (4,10). MRI is the most reliable diagnostic tool for spinal epidural CAs (5).…”

“…Owing to stagnant blood and slow blood flow, they are generally isointense on T1-WI and hyperintense on T2-WI (14,22). Contrast-enhanced T1-WI shows homogeneous enhancement because of much sinusoid structure in the tumor (4); nevertheless, sometimes heterogeneous signal can also be noticed due to intralesional hemorrhage or thrombus (10,14). The most striking difference in the MRI characteristics between epidural and intramedullary CAs is the lack of a ring of hypointensity from hemosiderin deposit (9,16).…”

“…Solitary epidural CAs not originating from the vertebral bone are relatively rare. With the aid of magnetic resonance imaging (MRI), solitary epidural CAs are being discovered in increasing numbers; nevertheless, most previous studies are case reports with an associated literature review and large series studies are very limited in the literature (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Because of the risk of spontaneous and intraoperative bleeding, solitary epidural CAs need to get neurosurgeons more attention.…”