Lumbar Spinal Epidural Capillary Hemangioma: A Case Report and Literature Review

Abstract

Patient: Female, 38-year-old Final Diagnosis: Spinal capillary hemangioma Symptoms: Leg cramp • low back pain • paresthesia • unsteady gait Medication: — Clinical Procedure: Surgical resection Specialty: Radiology Objective: Rare disease Background: Capillary hemangiomas are often seen on the skin of young individuals and are rarely found in the spine. These vascular lesions can arise from any spinal compartment, although they are more commonly found in the intradural extramedullary (IDEM) than the epidural location. We present a unique case of a woman with a histologically proven spinal epidural capillary hemangioma (SECH). The imaging and histopathological characteristics, as well as the treatment strategy of this vascular lesion, are highlighted along with a comprehensive review of the literature. Case Report: A 38-year-old woman presented with progressively worsening low back pain that radiated to both legs. Neurological examination revealed a weakness of the left leg without sensory loss. Magnetic resonance imaging (MRI) demonstrated an epidural tumor at L1–L2 level, making an obtuse angle with the cerebrospinal fluid (CSF) on sagittal T2-weighted images. The patient underwent a complete tumor resection without complications or recurrence. The histology revealed a capillary hemangioma. Conclusions: SECH is exceedingly rare, with only 22 cases in the reported literature. Females are more commonly affected than males, and the thoracic spine is more commonly involved than the lumbar spine. SECH often mimics other epidural and IDEM lesions, leading to misdiagnosis. MRI is useful to differentiate SECH from lesions in the various spinal compartments; additionally, MRI is essential for preoperative planning and patient surveillance. Preoperative embolization is an option given the high vascularity of SECH. Surgery is the mainstay treatment, with a good prognosis, in most cases without recurrence.

Spontaneous hemorrhage of spinal epidural capillary hemangioma resulting in hyperacute neurologic deficit: A case report

“…capillary hemangioma (SECH) that were reported previously in the literature. [4,5] According to the literature, magnetic resonance imaging (MRI) with contrast is the diagnostic modality of choice for all spinal cord lesions, including SECH. [4,6] Well-circumscribed margins (dumbbell shape) of the lesion and typically locates in the posterior portion of the spinal canal.…”

“…[4,5] According to the literature, magnetic resonance imaging (MRI) with contrast is the diagnostic modality of choice for all spinal cord lesions, including SECH. [4,6] Well-circumscribed margins (dumbbell shape) of the lesion and typically locates in the posterior portion of the spinal canal. [4,6,7] Furthermore, surgical resection is the mainstay treatment for SECH, with a good prognosis, in most cases without recurrence.…”

“…[4,6] Well-circumscribed margins (dumbbell shape) of the lesion and typically locates in the posterior portion of the spinal canal. [4,6,7] Furthermore, surgical resection is the mainstay treatment for SECH, with a good prognosis, in most cases without recurrence. [4,8] Here we report the 23rd case of capillary hemangioma in a 16-years-old female.…”

“…[4,6,7] Furthermore, surgical resection is the mainstay treatment for SECH, with a good prognosis, in most cases without recurrence. [4,8] Here we report the 23rd case of capillary hemangioma in a 16-years-old female. The great distinction of this case is that symptoms were hyperacute and developed within an hour.…”

“…[3] Most patients present in their fourth to fifth decades of life, with a median age of 49.2 years. [4] There is a slight predilection for females, with a male-to-female ratio of 9:13. [4] Hemangiomas constitute approximately 4% of all epidural tumors and 12% of all intraspinal hemangiomas.…”