Intraneural Growth of a Capillary Haemangioma of the Cauda Equina

Abstract

Solitary intraneural haemangiomas are very rare. A case of intraneural capillary haemangioma involving two nerve roots of the cauda equina is reported. The patient was a 63-year-old woman with a three years history of intermittent lumbalgia and numbness of the ventral surface of the left thigh. Magnetic resonance imaging detected an intradural extramedullary nodular space occupying mass at the level of the conus medullaris. Laminectomy of T12 and complete removal of the tumour were performed. Histopathological analysis demonstrated a capillary haemangioma. The tumour was located within the sheaths of a spinal nerve root. The lesion consisted of a myriad of small and very small vessels, reticularly arranged with normal nerve fascicles dispersed within the nodules of clustered capillaries. The present case of an intraneural capillary haemangioma of the cauda equina appears to be one of the first reported examples of this entity in the world's literature. The clinical presentation, diagnostic procedures and therapeutic options of intraneural haemangiomas of the conus medullaris and cauda equina are discussed. The current literature is reviewed.

A case of intraroot cauda equina cavernous angioma: clinical considerations

“…[1][2][3][4]6,15 The most common location of these vascular malformations is the supratentorial cerebral parenchyma. Cauda equina nerve root is a very rare location.…”

“…Cauda equina nerve root is a very rare location. 4,[9][10][11][12][13][15][16][17][18][19][21][22][23][24][25][26] Pagni et al 15 reviewed all intradural cavernous angioma of the spine described in the literature. They concluded that subdural extramedullary cavernous angiomas are the most rare of the cavernomas with only 10 cases documented between 1903 and 1990.…”

“…They can occur anywhere in the CNS, but they favor cerebral hemisphere. [1][2][3][4] In the spine, cavernomas are found far more frequently in the vertebral bodies and, when involve intradural space, they occur primarily within the spinal cord. [5][6][7] Intradural-extramedullary location is very rare, with only 23 cases reported in the literature accessible to us by Medline Research.…”

A 56-year-old Woman with a Right Arm Mass

“…Involved nerves have included the trigeminal, ulnar, median, digital, posterior tibial, and peroneal nerves [16,18,24,34,41]. Solitary intraneural hemangiomas within the sheaths of a lumbar spinal nerve root [22] and a nerve root of the cauda equina have also been reported [25]. Among the 13 cases reported in the literature [2, 6, 16-18, 20, 23, 24, 29-31, 42], there is no characteristic anatomic distribution; the median nerve is most commonly affected (six cases), followed by the tibial (three cases), ulnar, digital, sciatic, and superficial peroneal nerves.…”

“…Among the 13 cases reported in the literature [2, 6, 16-18, 20, 23, 24, 29-31, 42], there is no characteristic anatomic distribution; the median nerve is most commonly affected (six cases), followed by the tibial (three cases), ulnar, digital, sciatic, and superficial peroneal nerves. Solitary intraneural hemangiomas, confined to one or more nerve roots of the cauda equina [22,25] and the inferior trunk of the brachial plexus [3], have also been reported. All but one intraneural hemangioma occurred in children and young adults younger than 40 years; in all but two of the reported cases, the patients were women [3,41].…”