Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis

Abstract

Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2–3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma.

Spinal intradural extramedullary capillary hemangioma with coexistent spinal edema and syringomyelia successfully treated by tumor removal and cervical laminoplasty

“…[4,10] Spinal intradural extramedullary CH with detailed description has been previously reported [Table 1]. [1,3,4,[6][7][8][9][10][11][12][13] An adult case of spinal intradural extramedullary CH was first reported by Hanakita et al [24] The clinical symptoms related to spinal intradural extramedullary CH are chronic progressive myelopathy or radiculopathy resulting in motor or sensory deficits, though acute neurological aggravation due to intratumoral bleeding of intradural extramedullary CH has been reported. [10,31,34] Neurological deficits in our case were gradually progressing as typical manifestations of spinal intradural extramedullary CH.…”

“…[9] Lee et al speculated that the disturbed circulation of cerebrospinal fluid below spinal intradural extramedullary CH and possible minute bleeding from spinal intradural extramedullary CH could have been causative for syringomyelia and arachnoiditis. [9] In their case, preoperative syringomyelia on the conus medullaris and arachnoiditis aggravated even 1 year after the surgery on MRI. They discussed that intraoperative bleeding could have been responsible for the residual radiological findings.…”

“…They discussed that intraoperative bleeding could have been responsible for the residual radiological findings. [9] Intraoperative bleeding should be avoided not to result in such complications. In our case, spinal intradural extramedullary hemangioma was partially thrombosed and the single feeder was preoperatively detected.…”

“…[4] To the best of our knowledge, there has not been mentioned any case of spinal intradural extramedullary CH with coexistent spinal edema and syringomyelia successfully treated laminoplasty and tumor resection. [8][9][10]12,13] Here, we report a rare case of cervical intradural extramedullary CH accompanied by spinal edema and syringomyelia treated with laminoplasty and tumor resection.…”

“…[4] Coexistent spinal edema or syringomyelia with spinal intradural extramedullary CH has been previously described; however, the reported cases are still limited. [8][9][10][11][12] Regarding to surgical treatment for spinal intradural extramedullary CH, laminectomy and tumor resection seem to be usually performed. [4] To the best of our knowledge, there has not been mentioned any case of spinal intradural extramedullary CH with coexistent spinal edema and syringomyelia successfully treated laminoplasty and tumor resection.…”