Multiple Cavernous Angiomas of the Cauda Equina-Case Report-

Abstract

An 18-year-old male presented with multiple cavernous angiomas of the cauda equina manifesting as acute onset of severe low back pain radiating into the bilateral legs. Magnetic resonance imaging revealed a 20 mm by 15 mm nonenhanced, heterogeneous intensity intradural mass at the L-1 level, which had completely obliterated the spinal canal. After laminectomy at T12-L1 and dural incision, a 20 mm dark-bluish, mulberry-like tumor was seen, displacing the cauda equina circumferentially. After total removal of this tumor, four more small tumors were found adhering to different nerve roots, which were not resected. Histological examination revealed cavernous angioma. Although the postoperative course was uneventful, close observation of the residual tumors is required.

Coexistence of multiple cavernous angiomas in the spinal cord and skin: a unique case of Cobb syndrome

“…Of these 7 cases, 4 developed neurological deficits. 4,19 In our case, the origin of the cauda equina, as well as the conus medullaris, was encapsulated by adherent tumors that were difficult to dissect, and several pieces of tumor were attached to different nerve roots. Repetitive hemorrhage in and around CAs might induce inflammation, which causes adhesion of the tumor to its surrounding tissue.…”

“…A similar decision was made by Miyake et al, who left 4 pieces of a CA that was adherent to distinct nerve roots. 19 In addition, the difficulty in resecting angioma appears to be different between multiple angiomas and solitary angiomas. Multiple angiomas in the cauda equina failed to be completely resected in previous reports, 19,22 although solitary angiomas were safely resected.…”

Intra-Root Cavernous Angioma of the Cauda Equina : A Case Report and Review of the Literature

“…Of these six cases, four developed such neurological symptoms as paresthesia or muscle weakness 7,10,14) . The remaining two did not develop neurological deficits even following the dissection of nerve root 10,11) . In our case, cavernous angioma originating from the interior side of nerve root was identified under the fine microscopic guidance during the surgery.…”

“…This well illustrates that cavernous angioma arises from the blood vessels which originates from the nerve root of spinal cord. Of 14 cases of cavernous angioma occurring in cauda equina, which have been reported until now, six needed a surgical dissection of the nerve root 11) ( Table 1). Of these six cases, four developed such neurological symptoms as paresthesia or muscle weakness 7,10,14) .…”

“…Of them, 14 cases were developed in cauda equina. Most of these cases have been reported to occur between L1 and L3 11) . We experienced a symptomatic case of cavernous angioma which was present in the nerve root of cauda equina.…”