Pure Spinal Epidural Cavernous Hemangioma with Intralesional Hemorrhage: A Rare Cause of Thoracic Myelopathy

Abstract

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors.

Pure Spinal Epidural Cavernous Hemangioma: A Case Report

“…Cavernous hemangiomas may occur in any part of the body 8) . They mainly appear in the thoracic spine in an acute manner as the cord or conus are compressed 2,3,5,12,14) . Occurrence in the lumbar spine is very rare because nerve roots can tolerate compression better than the spinal cord; thus, it presents a chronic clinical course 3,7) .…”

“…Whereas lymphoma presents as isointense on T2-WI. In the case of angiolipoma, hyperintensity on T1-WI can be observed owing to its high fat content 1,[4][5][6][7][8][9][10][11][12][13][14] . Cavernous hemangiomas have a tendency to bleed and grow, so early surgical excision is recommended as soon as possible 14) .…”

Solitary spinal epidural cavernous haemangiomas as a rare cause of myelopathy

“…Radiculopathy can also be present secondary to foraminal extension of the tumour. Few cases describe sudden or intermittent symptoms due to haemorrhage within the lesion causing acute expansion 10 11. Pathological features include prominent thin-walled blood-filled vascular spaces within the lesion and, under high magnification, small foci of adipocytes within irregular fibrous intravascular septations.…”

“…Rarely, these tumours have been managed non-operatively in the setting of normal neurological examination or improvement 13. Despite this, surgical resection is still recommended, given the potential acute neurological deterioration due to intralesional haemorrhage 8 11…”

Pure spinal epidural cavernous hemangioma: A case series of seven cases

“…Cavernous hemangiomas (CH) although occur frequently in the intracranial structures are rare in the spine with “pure” primary epidural hemangiomas much more rare. [ 1 2 3 4 5 6 ] Spinal CHs occur with an incidence of 0.22 cases/million/year accounting for 5–12% of the spinal vascular lesions, 51% of which are extradural; most of them being secondary extensions from the vertebral lesions. Pure or primary (nonvertebral origin) spinal epidural CHs are very rare and account for only 4% of all the epidural lesions.…”