Spinal epidural cavernous hemangiomas

Abstract

Epidural cavernous hemangiomas are increasingly identified as a cause of acute or chronic progressive spinal cord syndrome and local back pain or radiculopathy. The authors present three cases of spinal epidural cavernous hemangiomas manifesting as spinal cord syndrome, thoracic radiculopathy, and lumbar radiculopathy. Based on the imaging characteristics of these three cases and a review of the literature, the clinical signs and symptoms and their implications, the role of preoperative neuroradiological diagnosis, and the need for complete surgical resection are discussed. Epidural cavernous hemangiomas display consistent magnetic resonance imaging properties: T1-weighted images most commonly show a homogeneous signal intensity similar to those of spinal cord and muscle, and contrast enhancement is homogeneous or slightly heterogeneous. On T2-weighted images the signal of the lesion is consistently high and slightly less intense than that of cerebrospinal fluid. Frequently, the lesion is characterized by its extension through the intervertebral foramen. Awareness of these characteristics facilitates diagnosis and treatment of the lesions. Despite the risk of bleeding, in all three cases complete surgical excision was achieved.

Review of Spinal Epidural Cavernous Hemangioma

“…Spinal epidural cavernous hemangioma without a primary origin in the vertebral bone is rare, with only 53 reported cases. 46,8,9,1117,19,20,2329,31,32,3439,42,43,45) Here we describe a typical case, as well as the clinical characteristics of this disease, especially the clinical course, differential diagnosis between this disease and other spinal extraaxial diseases, and surgical treatment.…”

Angioma cavernoso espinhal epidural: relato de caso

“…São lesões caracteristicamente intra-axiais, sendo que 78% dos casos localizam-se em região supratentorial e 22% em infratentorial 13 , podendo apresentar-se sob duas formas: esporádi-ca e familiar 12,14 . Nesta, as lesões são múltiplas e atribui-se um modo de transmissão autossômico domi- nante com alta penetrância e expressividade variadas 6 . Foi também descrita a associação desta entidade com nevus cutâneo familiar e a sua coexistên-cia com malformações cavernosas intracranianas 10,15 .…”

“…As primeiras incluem os tipos lesão de corpo vertebral, lesão de corpo vertebral com extensão epidural e lesão epidural pura e as últimas os tipos intradural extramedular e intramedular 5 . A maioria destas lesões, contudo, origina-se dos corpos vertebrais, podendo se estender para o espaço extradural 1,3,6,15,16 . A ocorrência de angioma cavernoso extradural primário tem sido referida como incomum [1][2][3] e constitui aproximadamente 4% de todos os tumores espinhais epidurais 13 .…”

“…No presente relato descrevemos um caso de angioma cavernoso espinhal epidural e discorremos sobre aspectos clínicos, diagnósticos e terapêuticos desta patologia. A apresentação clínica mais comum é a de síndrome medular de evolução lenta e progressiva [4][5][6] . A ressonância magnética (RM) é o método de imagem de escolha para diagnóstico 5 e a cirurgia é o tratamento de escolha para estas lesões 4,5,7 .…”

Preferred Surgical Approach for Dumbbell-shaped Tumors in the Posterior Mediastinum

“…Massive bleeding in the spinal canal is the most frequent reason for permanent cord injury and incomplete resection of tumors involving the spinal canal. 1,2) Thoracoscopic surgery is far less suitable than a thoracotomy for managing hemorrhagic tumors. In this case, we first ligated the feeding arteries of the tumor via a thoracotomy, so we were able to complete the tumor resection without major complications.…”