Spinal Capillary Hemangioma in Infants: Report of Two Cases and Review of the Literature

Abstract

We report the case of 2 infants born with a lumbar dermal sinus tract and an overlying angiomatous skin lesion referred to our pediatric neurosurgery service for evaluation of a tethered cord. Both infants were born with a lumbar dimple and were found to have a large cutaneous hemangioma without neurologic symptoms. An MRI of the lumbar spine revealed an isointense mass in the dorsal epidural at L₄ with an adjacent mass effect and extension into the overlying soft tissues. The spinal cord also appeared to be tethered with a fatty filum terminale. We performed a lumbar laminectomy and laminoplasty to remove the mass and to release the tethered cord. Pathologic examination confirmed the diagnosis of capillary hemangioma. Several case reports describe spinal capillary hemangiomas in adults, but only one found in the literature describes a case in an infant. We provide a review of the literature of spinal capillary hemangiomas and support the practice of evaluating infants with cutaneous lumbosacral hemangiomas for underlying spinal cord abnormalities.

A Case of Cerebellar Capillary Hemangioma with Multiple Cysts

“…These involved 5 male and 5 female patients aged from 6 weeks to 31 years (mean 12.1 years), including 3 infants. Karikari et al [3 ]reviewed 25 male and 12 female cases of spinal capillary hemangiomas in patients aged from 28 to 80 years and 1 infant. It seems that among capillary hemangiomas of the central nervous system, intracranial capillary hemangiomas occur in younger patients (without a gender difference) in comparison to spinal capillary hemangiomas.…”

“…There have been several recent reports of spinal capillary hemangiomas, however, arising in the spinal cord, nerve root, conus medullaris or cauda equina [2, 3], and only 10 reported cases of intracranial capillary hemangioma that were confirmed histologically [2,4,5,6,7,8,9,10]. …”

Infantile Hemangiomas Involving the Neuraxis: Clinical and Imaging Findings

“…There are only scattered reports of true infantile hemangiomas involving the central nervous system (CNS). [3][4][5][6][7][8][9][10][11][12] Approximately 60% of infantile hemangiomas occur in the craniofacial region. 13 The lesions are described as superficial, deep, or of combined depth.…”

Spinal dysraphism associated with the cutaneous lumbosacral infantile hemangioma: a neuroradiological review

“…5 Sagittal (a) and axial (b) T1-weighted MR images without fat saturation reveal a linear low signal band (white arrows) extending from the skin surface to the terminal lipoma, which is consistent with a dorsal sinus tract lumbosacral cutaneous IHs were present. Two patients in the literature with intraspinal hemangioma were initially asymptomatic, but one of them presented at age 7 months with lower extremity apraxia [14]. The biological behavior and course of intraspinal IH have not been studied well, but presumably its behavior mimics cutaneous IH with a rapid growth and proliferative phase in the first 2 to 6 months of life.…”