Cauda Equina Intradural Extramedullary Cavernous Haemangioma—Case Report and Review of the Literature

Abstract

Cavernous haemangioma (cavernoma) is a benign vascular lesion, exceptionally located in cauda equina. We report a case, diagnosed and operated in the Department of Neurosurgery from Pitesti County Emergency Hospital, of a 60-year-old woman with history of lumbar region distress, who presented with low back pain, paravertebral muscle contracture, and bilateral lumbar radiculopathy, with sudden onset after lifting effort. The preoperative diagnosis was done using computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery—two level laminectomy, dural incision, and tumor dissection from the cauda equina nerve roots under operatory microscope. Histopathological examination confirmed the positive diagnosis of cavernoma of cauda equina. The patient's outcome was favorable, without postoperative neurological deficits.

Cervical intradural extramedullary cavernous malformation as a rare cause of subarachnoid hemorrhage without spinal dysfunction: illustrative case

“…[8][9][10][11][12] Due to compression of the nerve root or spinal cord, the lesions become clinically evident with localized back pain, radiculopathy, and spinal dysfunction (sensorimotor deficit, sphincter dysfunction) and in some cases even with SAH according to recurrent bleeding. 8,13 Spinal cavernoma associated with SAH has been described at both the thoracic and lumbar levels. 9,10,14,15 Interestingly, two cases associated with hydrocephalus 16,17 and two further cases associated with cerebral hemosiderosis due to chronic subarachnoid bleeding have been described.…”

“…8–12 Due to compression of the nerve root or spinal cord, the lesions become clinically evident with localized back pain, radiculopathy, and spinal dysfunction (sensorimotor deficit, sphincter dysfunction) and in some cases even with SAH according to recurrent bleeding. 8 , 13 …”

Spinal intramedullary cavernomas. Personal experience reffering to six cases

“…-asymptomatic, accidentally found at autopsy in patients with multiple cavernous angiomas; -gradual slow neurological deterioration over months to years (8), with acute episodes lasting for hours to days, with possible neurological recovery between episodes generated by small hemorrhages or acute thrombosis with organization and recanalization -mild neurological symptoms, with progressive myelopathy, the most frequent mode of presentation, of gradual decline during weeks to months or even acute onset, events related to changes in the microcirculation surrounding the lesions and to the neurotoxic effect of hemosiderin; -acute complete paralysis, fortunately not common but seen in pediatric population (13), due to hemorrhage extension into the spinal parenchyma, similar to cauda equine cavernoma (26) where intratumoral microbleeding may generate acute onset.…”

Intradural extramedullary cavernous malformation with extensive superficial siderosis of the neuraxis: Case report and review of literature

“…[11] Only 3% of spinal cavernomas are intradural, with intradural-extramedullary lesions being more rare compared with intramedullary locations. [8] Most patients present with symptoms related to spinal cord compression.…”

“…Spinal cavernous malformations (cavernomas or cavernous hemangiomas) are infrequent vascular malformations which occur primarily in the vertebral body, with or without extradural extension, that constitute 5–12% of all spinal vascular abnormalities. [ 11 ] Only 3% of spinal cavernomas are intradural, with intradural-extramedullary lesions being more rare compared with intramedullary locations. [ 8 ] Most patients present with symptoms related to spinal cord compression.…”