Primary Epidural Hemangiopericytoma in the Lumbar Spine

Ijiri, Kosei; Yuasa, Shinya; Yone, Kazunori; Matsunaga, Shunji; Ryoki, Yoshihiro; Taniguchi, Noboru; Yonezawa, Suguru; Komiya, Setsuro

doi:10.1097/00007632-200204010-00020

Cited by 34 publications

(13 citation statements)

References 23 publications

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“…The presence of intradural perimedullary vessels and arteriovenous shunting were not described. The diagnosis in this case, in addition to the other case reports of intradural hemangiopericytomas, [5][6][7] was presumed to be a meningioma or neurofibroma intraoperatively, suggesting that no abnormal intradural vasculature was identified. Similar to this case, several other cases reported a primary pain component to the presentation of the tumor with lower extremity paresthesias, bladder dysfunction, and no defined motor weakness.…”

Section: Discussionsupporting

confidence: 46%

Intradural Hemangiopericytoma of the Lumbar Spine: A Rare Entity

Fitzpatrick¹,

Mahajan²,

Lewkowitz³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We report a case of a patient with an intradural hemangiopericytoma of the lumbar spine and the unusual MR angiography (MRA) and spinal angiography findings of arteriovenous shunting with spinal venous congestion. We highlight the concordance of the unusual MRA and angiographic findings and their relationship to combined endovascular and surgical therapy. H emangiopericytomas, initially described by Stout and Murray, 1 are vascular tumors derived from pericytes, the smooth muscle cells that control the diameter of the capillaries. The mass itself is composed of numerous capillaries with an intact basement membrane, with the neoplastic pericytes in the extravascular space.2 Hemangiopericytomas may be considered benign or malignant, have been identified in all age groups, and demonstrate no sexual predisposition.3 Primary spinal hemangiopericytomas are rare, with only 39 reported cases in the literature, those being primarily extradural.We describe the unique presentation of a lumbar intradural hemangiopericytoma that produced imaging findings consistent with an arteriovenous shunt, with congested spinal veins and concordant spinal MR angiography (MRA) and conventional angiographic findings. Endovascular embolization of the hemangiopericytoma was performed to treat the arteriovenous shunt and prevent excessive intraoperative blood loss. In addition, the enlarged radicular vein was ligated during surgery to definitively prevent any myelopathic complications. Case ReportA 54-year-old man presented to our emergency department with left paraspinal, buttock, and anterolateral thigh pain that radiated down the anterior shin and left foot. Initial noncontrast MR examination revealed a lesion in the left L4-L5 neural foramen, which was soft tissue signal intensity on all sequences. Serpiginous, intradural signal intensity voids were identified in the lumbar spinal canal without change in signal intensity in the cord (Fig 1). Contrast-enhanced spinal MRA and postcontrast images were recommended to elucidate the nature of the intradural flow voids and better define the neuroforaminal mass.The L4-L5 neuroforaminal mass enhanced with contrast (Fig 2). MRA (Fig 3, left) of the lumbar spine demonstrated prominent intradural vessels contiguous with the mass with congested pial veins, compatible with a spinal arteriovenous fistula or arteriovenous malformation. Spinal angiographic examination was recommended both to further elucidate the relationship between the soft tissue mass and the abnormal surface veins and for possible perioperative intervention.Spinal angiography (Fig 3, right) revealed a hypervascular mass in the left L4 recess with radicular venous drainage and filling of congested intradural veins ascending to the level of the conus, where congested anterior and posterior spinal veins were apparent. Devascularization of the tumor was performed without residual tumor blush and disappearance of the apparent arteriovenous shunting accounting for spinal venous congestion. At surgery, the L4-L5 nerve sheath was inc...

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Section: Discussionsupporting

confidence: 46%

Intradural Hemangiopericytoma of the Lumbar Spine: A Rare Entity

Fitzpatrick¹,

Mahajan²,

Lewkowitz³

et al. 2008

AJNR Am J Neuroradiol

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“…Hemangiopericytoma of the spinal axis [28, 29] is a well-recognized entity considered to be an aggressive neoplasm with a high rate of recurrence and a propensity to metastatize. As it originates from Zimmerman’s pericyte of the capillaries, it can occur at various sites where capillaries are present.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Extradural Spinal Tumors

Kumar

Giri²

2008

Pediatr Neurosurg

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We have reviewed 16 children with extradural spinal tumors, both benign and malignant, treated from 1998 to 2006 in Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. The duration of symptomatology, clinical signs, radiological investigations, surgical approach, outcome and histopathological variation from the Western world was noted and evaluated. The age of these children ranged from 3 to 20 years. There were 11 boys and 5 girls. The duration of symptoms was 2–18 months, relatively longer in benign (mean 9.5 months) than malignant (mean 4.2 months) tumors. The follow-up ranged from 3 to 72 months and patients were graded preoperatively and postoperatively with the McCormick Functional Grading System. There was significant improvement in grade III–V patients, i.e. 74% of patients were grade III–IV at presentation, and only 35% at the last follow-up. There was deterioration from grade III to grade IV in 2 patients (PNET + metastatic adenocarcinoma) and 2 patients (neuroblastoma + Ewing’s sarcoma) maintained their grades of IV and V, respectively. There was a wide range of histological variants seen in our series and the patients were treated primarily with a suitable surgical approach and adjuvant chemoradiotherapy, wherever indicated.

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“…En el grupo de los tumores malignos primarios se encuentra los linfomas extranodales, el sarcoma de Ewing, el hemangiopericitoma y el liposarcoma 5,8,14,15,25 . El diagnóstico diferencial debe establecerse fundamentalmente entre el angiolipoma, el hematoma epidural vertebral espontáneo y la lipomatosis 9,21,28 .…”

Section: Discussionunclassified