Spinal epidural cavernous haemangioma: a case report and review of literature

Goyal, Ashish; Singh, Anil Kumar; Gupta, Vikas; Tatke, Medha

doi:10.1038/sj.sc.3101248

Cited by 51 publications

(51 citation statements)

References 16 publications

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“…A pure epidural cavernous hemangioma was first reported in 1929 [5]. In contrast to the present case, which was a male patient, a majority of these tumours occur in women [2].…”

Section: Discussioncontrasting

confidence: 48%

A Pure Epidural Spinal Cavernous Hemangioma — With an Innocuous Face But A Perilous Behaviour!!

Hemalatha¹,

Ravikumar²,

Chamarthy³

et al. 2013

JCDR

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Cavernous hemangiomas occur frequently in the intracranial structures but they are rare in the spine, with an incidence of 0.22 cases/million/year, which account for 5 -12% of the spinal vascular lesions, 51% of which are extradural. Most of the epidural hemangiomas are secondary extensions from the vertebral lesions. The spinal cavernous hemangiomas which do not involve the vertebrae are referred to as "pure" types. The pure epidural hemangiomas are rare, which account for only 4% of all the epidural lesions.A case of a Pure spinal epidural cavernous hemangioma in a 50 year old male, with the clinical picture of a slowly progressive compressive myelopathy, has been presented here.The imaging studies showed a well-defined, enhancing epidural lesion at the T7 -T8 level, with dorsal cordedema and myelomalacic changes. A radiological diagnosis of a meningioma was considered. Histopathologically, the lesion was diagnosed as a hemangioma. The patient improved dramatically after the excision of the lesion. CASe RepoRTA 50 year old male presented with a history of progressive weakness in both the lower limbs since 1 year. He also complained of inability in walking, lifting or appreciating sensations in the lower limbs, as well as loss of the bowel and bladder control. The general examination revealed no significant abnormalities. A detailed Central Nervous System (CNS) examination showed no neurological deficit in the upper limbs. The lower limbs were flaccid, with a reduced bulk and a power of grade 1/5. A loss of sensation was observed upto the groin crease. An examination of the spine revealed no tenderness or deformity. The systemic examination showed no abnormality. The routine haematological investigations showed mild anaemia. Magnetic Resonance Imaging (MRI) of the dorsal spine showed a well-defined, oval, enhancing lesion which measured 4.4 x 1.3 x 2.0 cm, in the posterior epidural compartment, at the T7 -T8 level, with dorsal cord oedema and early myelomalacia. The lesion was homogenously iso-intense in the T1 images and it was hyperintense in the T2 images, with effacement of the subarachnoid space posteriorly. The spinal cord showed mild extension into the neural foramina. The radiological diagnosis which was offered was meningioma [Table/ Fig-1].The patient underwent laminectomy from the T7-T8 level. Peroperatively, an epidural reddish brown mass which measured 6x2 cm at the T7-T8 level, with no dural attachment, or spinal extension or bony involvement, was observed. The excised mass was subjected to a histopathological examination.the histopathological examination findings were as follows: The gross examination of the specimen showed a single, brownish black, soft tissue mass which measured 3.5 x 1.5 x 0.5 cm. The cut section showed a brown black colour with a spongy appearance. The microscopic examination showed a benign tumour which was composed of vascular spaces of variable sizes, with fibrocollagenous walls which were lined by a single layer of flattened endothelial cells. The lumina containe...

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“…A pure epidural cavernous hemangioma was first reported in 1929 [5]. In contrast to the present case, which was a male patient, a majority of these tumours occur in women [2].…”

Section: Discussioncontrasting

confidence: 48%

A Pure Epidural Spinal Cavernous Hemangioma — With an Innocuous Face But A Perilous Behaviour!!

Hemalatha¹,

Ravikumar²,

Chamarthy³

et al. 2013

JCDR

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“…-nerve sheath tumors are linear, ovoid or characteristically dumbbell-shaped in configuration, of uniform hyper-intense signal in T2 -disk prolapse -ruled out for its lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root, after Gadolinium injection -with heterogeneous signal in T2 (20) -paraganglioma rarely occurs epidurally, with heterogeneous salt and pepper appearance due to vascular signal voids on MR imaging mimicking capillary hemangioma (6) (42) -epidural lymphoma shows characteristic low T2 signal -drop metastasis usually appears as multiple small nodular and/or linear enhancing lesions within the thecal sac (10) -filum terminale ependymoma may present intratumoral cystic changes and a less strong degree of contrast enhancement -round cell tumor -eosinophilic granuloma, ruled out for the absence of any bony changes -sarcoidosis (43), lymphoma with a discrete solitary mass, with a multifocal patchy or linear enhancing lesion -histiocytosis, angiolipoma -representing less than 6% of all spinal neoplasms -tuberculosis is uncommon, mostly epidural, associated with other systemic signs and symptoms as well as with mediastinal lymphadenopathy, with craniocaudal extension along to more than one vertebral body.…”

Section: Discussionmentioning

confidence: 99%

“…Cavernous hemangioma, also known as: cavernous angioma, cavernoma, cavernous malformation or hemangioma is a developmental vascular anomaly of dilated blood vessels collection; represent about 7% of all vascular malformations, it can occur anywhere in the central nervous system, with approximately 5% of the cases located in the spine (1)(2)(3)(4)(5)(6)(7). Either capillary or cavernous, intradural, spinal, extramedullary hemangiomas can be solitary or multiple; they are well-defined lesions composed of blood-filled endothelial spaces lined by thickened, hyalinised walls without elastic fibers or smooth muscle; they are also very rare (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

Iacob¹,

Rotund²,

Iancu³

et al. 2017

Romanian Neurosurgery

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A very rare, purely intradural, spinal, extramedullary cavernous hemangioma was fortunately discovered in a 56 years old woman, presenting with bilateral brachial paresthesia. Using conventional spin-echo T1 proton density,T2-weighted magnetic resonance and gadolinium images an intradural spinal T4-T5, an extramedullary cavernous hemangioma was discovered. The patient underwent surgery, with laminectomy and microsurgical resection followed by an uneventful postoperative clinical course. Similar as in cerebral locations a mixed signal intensity in all sequences on magnetic resonance images might be indicative of cavernous hemangioma, rendering a presumptive preoperative diagnosis of the lesion and surgical planning for a good microsurgical resection.

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“…Various different diseases can cause sixth nerve palsy, neoplasic and traumatic etiologies being more common in children, while vascular and idiopathic are responsible for the majority of cases in adult population 2 .…”

Section: Bilateral Traumatic Avulsion Of Abducens Nervementioning

confidence: 99%

“…Most of these malformations are intracranial: supratentorial compartment is a site usually affected 2,3 . Pure spinal epidural cavernomas represent approximately 12% of spinal cavernous anomalies 4 and the thoracic segment is the most frequently affected 5 .…”

mentioning

confidence: 99%

Extradural cavernous hemangioma of thoracic spine

Antunes

Beck²,

Strapasson³

et al. 2011

Arq. Neuro-Psiquiatr.

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Cavernous hemangioma of the central nervous system is a vascular malformation which is a developmental hamartoma, also known as cavernoma or cavernous malformation or venous angioma 1 .Cavernomas may affect any segment of the neuraxis. Most of these malformations are intracranial: supratentorial compartment is a site usually affected 2,3 . Pure spinal epidural cavernomas represent approximately 12% of spinal cavernous anomalies 4 and the thoracic segment is the most frequently affected 5 . There are approximately 80 cases of epidural cavernous hemangioma published in the literature 4,5 .We report on a case of thoracic extradural cavernous hemangioma, with emphasis on the clinical aspects. CASEA 63-years-old female caucasian patient with a previous history of cryptogenic epilepsy was referred to our emergency department with complaints of a one year history of gait ataxia, numbness and dysesthesia in both lower limbs. In the last 2 months, she also noticed reduced strength in the lower limbs.Neurological examination showed reduced strength in the lower limbs, grade 4/5 in the right lower limb and grade 3/5 in the left one. There was reduced sensation for all sensory modalities below the T10-11 dermatomes. There was also lower limb hyperreflexia and hypertonia, with bilateral extensor plantar response.An MRI showed an epidural space-occupying lesion involving the T9-T10 spinal canal levels and extending to the T9 left foramen, with an intense and homogeneous contrast enhancement (Figure).The patient was submitted to a T9-T10 laminectomy, including a T9 left foraminectomy. A posterior soft and reddish epidural mass with a good cleavage plan was completely removed. The patient evolved with partial improvement of sensibility in both lower limbs and strength.Histological examination revealed thin-walled blood vessels lined with a single layer of endothelial cells, surrounded by connective tissue. The microscopic appearance was compatible with cavernous hemangioma.

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Spinal epidural cavernous haemangioma: a case report and review of literature

Cited by 51 publications

References 16 publications

A Pure Epidural Spinal Cavernous Hemangioma — With an Innocuous Face But A Perilous Behaviour!!

A Pure Epidural Spinal Cavernous Hemangioma — With an Innocuous Face But A Perilous Behaviour!!

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

Extradural cavernous hemangioma of thoracic spine

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