Intradural extramedullary cavernoma of a lumbar nerve root mimicking neurofibroma. A report of a rare case and the differential diagnosis

Spinal Cavernous Hemangioma in a Pediatric Patient - A Case Report

“…Symptoms include back, neck, and/or spinal pain, sensorimotor deficits, paraparesis, bowel and urinary disturbance, and altered reflexes. Brown-Sequard syndrome and progressive cord dysfunction are also reported [2]. Progressive myelopathy caused by typical microhemorrhages and perifocal gliosis probably explains the neurological decline of affected patients.…”

“…In the longterm, this process leads to enlargement, fibrosis, and calcification of the lesion itself. Microhemorrhages may further obstruct and thrombose the vascular canals that again may lead to necrosis of the thin vessel walls and may cause further hemorrhages [2].…”

“…Surgical procedures may be technically difficult, due to the formation of dense adhesions between the cavernous hemangioma and the nerve roots. In some cases, dissection of the nerve roots that are assumed to be the origin of the mass is unavoidable [2]. Embolization has no role in the treatment of most cavernous hemangiomas of the spine [16] and no adjuvant therapy is needed [18].…”

“…Approximately 3% of spinal cavernous hemangiomas are intradural, usually with an intramedullary location. Epidural cavernous hemangioma of the spine, account for approximately 4% of these vascular epidural lesions [2].…”

Intradural extramedullary cavernous hemangioma of the cervicothoracic junction: A case report and review of the literature

“…[ 7 , 11 ] Primarily located in the lumbar and lower thoracic spine, with only four cases of tumors described at the cervicothoracic junction, cavernous hemangiomas exhibit benign behavior, although hypertrophy and reorganization of aberrant cells can lead to progressive growth with subsequent mass effect on the surrounding structures. [ 8 ] Secondary edema formation occurs most likely due to the interplay of thrombotic obliterations and recurrent microhemorrhages, which may be the cause of the progressive neurological decline. [ 5 ] Frequently observed clinical manifestations include gradually progressive nerve root compression, and, in some reported cases, including the present, progressive myelopathy, leading to motor and sensory deficits.…”