Illustrative resection of mixed intra- and extramedullary thoracic spinal cord capillary hemangioma

Abstract

Background: Capillary hemangiomas are typically superficial benign tumors of the cutaneous and mucosal tissues of the face and neck in pediatric patients. In adults, they typically occur in middle-aged males who present with pain, myelopathy, radiculopathy, paresthesias, and bowel/bladder dysfunction. The optimal treatment for intramedullary spinal cord capillary hemangiomas is gross total/en bloc resection. Methods: Here, we present a 63-year-old male with increasing right greater than left lower extremity numbness/ weakness, attributed to a T8-9 mixed intra- and extramedullary capillary hemangioma. Results: One year following complete lesion resection, the patient used an assistive device to ambulate and continued to improve neurologically. Conclusion: We presented a 63-year-old male whose paraparesis was attributed to a T8-9 mixed intra- and extramedullary capillary hemangioma who did well following total en bloc lesion resection. In addition to this case study/technical note, we provide a 2-D intraoperative video detailing the resection technique.

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.…”

“…2) Most intramedullary lesions occurred in middle-aged males (0-80 years old, median age = 56, male: female = 28:3). 1,3,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21] Cases in children are extremely rare. 10,15,21) Cases of multiple lesions 19) or intraneural cauda equina lesions 22) have also been reported.…”

“…2) The appearance of any of the symptoms of back pain, lower limb weakness, and lower limb numbness are reportedly associated with intramedullary capillary hemangiomas. 1,3,6,8,9,[12][13][14][16][17][18][19][20] Some pa-tients with intramedullary capillary hemangiomas reported that the duration of illness was several years, 18) whereas others reported that it was several months 1) (Table 1). Along with severe spinal cord edema, intramedullary capillary hemangiomas can cause progressive neurological symptoms, as in our case.…”