Intradural-extramedullary Spinal Cavernoma

McQueen, Sydney; Haji, Faizal; Figueroa, Enriqueta Lúcar; Sallam, Yasmine; Ang, LC; Duggal, Naven

doi:10.1017/cjn.2022.287

Cited by 3 publications

(4 citation statements)

References 9 publications

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“… 1–4 , 6–15 Remarkably, within this rare category, only 4 presented with SAH, and the remainder presented with subacute-chronic radiculopathy, myelopathy, and/or back pain. 12 , 13 …”

Section: Discussionmentioning

confidence: 99%

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Thoracic root–related intradural extramedullary cavernoma presenting with subarachnoid hemorrhage: illustrative case

Martins Coelho Junior,

Toop,

Kobalka

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Just 5% of all cavernomas are located in the spine. Thoracic root–related subtypes are the rarest, with a total of 14 cases reported in the literature to date. Among them, only 4 presented with subarachnoid hemorrhage (SAH). OBSERVATIONS A 65-year-old female presented after an ictus of headache with no neurological deficits. Computed tomography (CT) demonstrated sulcal SAH, with the remainder of the workup nondiagnostic for etiology. Three weeks later, she re-presented with acute thoracic back pain and thoracic myelopathy. CT and magnetic resonance imaging suggested dubiously a T9–10 disc herniation with spinal cord compression. Surgical decompression and resection were then planned. Intraoperative ultrasound (IUS) demonstrated an intradural extramedullary lesion, confirmed to be cavernoma. Complete resection was achieved, and the patient was discharged a few days postoperatively to inpatient rehabilitation. LESSONS Although spine imaging is deemed to be low yield in the evaluation of cryptogenic SAH, algorithms can be revisited even in the absence of spine-related symptoms. Surgeons can be prepared to change the initial surgical plan, especially when preoperative imaging is unclear. IUS is a powerful tool to assess the thecal sac after its exposure and to help guide this decision, as in this rare entity.

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“… 1–4 , 6–15 Remarkably, within this rare category, only 4 presented with SAH, and the remainder presented with subacute-chronic radiculopathy, myelopathy, and/or back pain. 12 , 13 …”

Section: Discussionmentioning

confidence: 99%

“…in 1965, in a young patient experiencing sphincter dysfunction. 3 , 12 , 13 Overall, 72 surgically treated cases have been reported in the literature. 12 , 13 …”

mentioning

confidence: 99%

Thoracic root–related intradural extramedullary cavernoma presenting with subarachnoid hemorrhage: illustrative case

Martins Coelho Junior,

Toop,

Kobalka

et al. 2024

Journal of Neurosurgery: Case Lessons

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“…Spinal cavernous malformations account for approximately 20% of intramedullary tumors, 4 and intradural extramedullary cavernomas are the least frequent in the spinal cord, with 71 cases described to date. 5 The clinical manifestation can vary from progressive to acute neurological decline, with SAH as one of the possible presentations due to superficial localization. 4 , 6 …”

mentioning

confidence: 99%

Adhesive arachnoiditis, subarachnoid hemorrhage, and intradural extramedullary thoracic cavernoma: illustrative case

Andriuskeviciute,

Mondragón-Soto,

Penet

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Spinal arachnoiditis can result from various factors, including spinal subarachnoid hemorrhage (sSAH). In this paper, the authors describe a case of intradural extramedullary cavernoma with an initial presentation of subarachnoid hemorrhage leading to multilevel spinal arachnoiditis to discuss the pathophysiology and optimal treatment strategy. OBSERVATIONS Spinal intradural extramedullary cavernoma manifesting with sSAH is a rare clinical presentation; therefore, there is no clear strategy for the management of sSAH. Spinal arachnoiditis is a result of chronic inflammation of the pia arachnoid layer due to hematomyelia. No effective treatment that interrupts this inflammatory cascade and would also prevent the development of spinal arachnoiditis has been described to date. LESSONS Lumbar drainage could aid in sSAH management, relieve spinal cord compression, and restore the normal spinal cerebrospinal fluid circulation gradient. It could help to clear the blood degradation products rapidly and prevent early inflammatory arachnoiditis development. Mini-invasive intrathecal endoscopic adhesiolysis appears to be a reasonable approach for reducing the risk of aggravating spinal arachnoiditis with a mechanical-surgical stimulus. Whether a conservative approach should be applied in these patients with mild myelopathy symptoms is still debatable.

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“…[1][2][3] Intradural extramedullary cavernomas of the spinal cord are especially rare, with only 71 cases previously described. 4 As with cavernous malformations elsewhere in the central nervous system, these lesions are susceptible to spontaneous hemorrhage. As such, surgical resection in symptomatic cases is indicated to prevent neurological decline.…”

mentioning

confidence: 99%

Resection of a Thoracic Intradural Extramedullary Cavernoma Using Real-Time Intraoperative Ultrasound: 2-Dimensional Operative Video

Tawil¹,

Chryssikos²,

Ben-Natan³

et al. 2023

Operative Neurosurgery

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Intradural-extramedullary Spinal Cavernoma

Cited by 3 publications

References 9 publications

Thoracic root–related intradural extramedullary cavernoma presenting with subarachnoid hemorrhage: illustrative case

Thoracic root–related intradural extramedullary cavernoma presenting with subarachnoid hemorrhage: illustrative case

Adhesive arachnoiditis, subarachnoid hemorrhage, and intradural extramedullary thoracic cavernoma: illustrative case

Resection of a Thoracic Intradural Extramedullary Cavernoma Using Real-Time Intraoperative Ultrasound: 2-Dimensional Operative Video

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