Spinal Epidural Hemangiomas: Various Types of MR Imaging Features with Histopathologic Correlation

Lee, Joon Woo; Cho, E.Y.; Hong, Sung Hwan; Chung, Haniee; Kim, J.H.; Chang, Kee-Hyun; Choi, Ja Young; Yeom, Jin S.; Kang, Hyejung

doi:10.3174/ajnr.a0563

Cited by 68 publications

(76 citation statements)

References 15 publications

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“…Preoperative MRI is necessary for accurate diagnosis of spinal epidural CM [1,9,14,18]. These lesions tend to display iso-signal or low signal on T1WI and high signal on T2WI, with homogeneous enhancement after injection of contrast material, most of which are located in the posterior epidural space and present with myelopathy [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Morioka et al proposed to differentiate these tumors and spinal CM by enlargement of intervertebral foramina, suggesting that the latter is rarely likely to cause dilation compared to the former [6]. Conversely, this proposal is contradicted by Lee et al, who found that CM usually leads to a neural foraminal widening [18]. These lesions not only show dilated intervertebral foramina, but also tend to invade the vertebral body, and pedicle of vertebral arch, with heterogeneous enhancement and enhance less than spinal CMs and usually with cystic changes, which is different from spinal epidural CMs.…”

Section: Discussionmentioning

confidence: 99%

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Spinal dumbbell-shaped epidural cavernous hemangioma (CM): report of nine surgical cases and literature review

Zhang

Yang

et al. 2018

Chin Neurosurg Jl

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Background: Spinal dumbbell-shaped epidural cavernous malformation (CM) is a rare, hypervascular entity frequently misdiagnosed for other lesions, leading to unexpected intraoperative bleeding and suboptimal resection. Our study aims to elucidate the demographics, management strategy, and outcome of this vascular disease. Methods: Retrospective review of patients seen in Beijing Tiantan Hospital with symptomatic dumbbell-shaped epidural CM from 2008 to 2013. All lesions were pathologically confirmed after resection. The clinical manifestations, radiographic features, and treatment modalities of these cases were analyzed. Results: We included 9 consecutive patients. Average age was 58 ± 12 years (range: 34-79 years), with 66.7% male. Locations of the CMs were: thoracic (n = 7, 77.8%), cervical (n = 1, 11.1%), and cervicothoracic junction (n = 1, 11.1%). Only one case presented with acute manifestations while others experienced chronic progressive spinal cord symptoms. The initial clinical diagnoses were: schwannoma (n = 6, 66.7%), cavernous hemangioma (CM) (n = 1, 11. 1%), meningioma (n = 1, 11.1%), and angioma (n = 1, 11.1%). Total resection was achieved in six patients (66.7%), and partial resection in the other three patients (33.3%). Average intraoperative blood loss was 400 ± 300 ml (range: 100-1000 ml). During an average follow-up of 71 ± 21 months (range: 29-94 months), excellent outcome was achieved in seven cases (77.8%), one partially improved (11.1%), and one deteriorated (11.1%). No patients experienced recurrence of symptoms. Conclusions: Spinal dumbbell-shaped epidural CM is a benign vascular malformation that should be differentiated from other dumbbell-shaped lesions. Accurate preoperative diagnose is challenging as no specific radiographic marker has been established. Total surgical resection should be recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spinal dumbbell-shaped epidural cavernous hemangioma (CM): report of nine surgical cases and literature review

Zhang

Yang

et al. 2018

Chin Neurosurg Jl

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“…An accurate diagnosis depends on pathology. Histologically, CAs must be distinguished from arteriovenous malformations and capillary hemangiomas (27,28). The arteriovenous malformation shows with a cluster of abnormal arteries and veins and vessel walls containing elastin, and smooth muscle (28).…”

Section: Discussionmentioning

confidence: 99%

“…Histologically, CAs must be distinguished from arteriovenous malformations and capillary hemangiomas (27,28). The arteriovenous malformation shows with a cluster of abnormal arteries and veins and vessel walls containing elastin, and smooth muscle (28). The characteristic features of capillary hemangioma are thin irregular capillary-sized vessels caught in low attenuating fibroses, lobular architecture and the presence of a lining of a continuous basal lamina (29).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas

2018

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Abstract. The majority of spinal cavernous angiomas (CAs) originate from the vertebral bodies with or without epidural space extension. Solitary epidural CAs are rare. In the present study, we retrospectively reviewed the records of 12 patients who underwent microsurgery for solitary spinal epidural CAs. All patients had performed pre-and postoperative magnetic resonance imaging. The patients were 7 females and 5 males with the mean age of 52.1 years. Two tumors were located in the cervicothoracic spine, nine in the thoracic spine and one in the lumbar spine, respectively. Solitary epidural CAs generally exhibited isointensity on T1-weighted images and hyperintesity on T2-weighted images. Contrast-enhanced T1-weighted images showed homogeneous markedly enhancement. Gross total resection (GTR) was achieved in 11 cases, and subtotal resection (STR) was achieved in 1 case. During an average follow up of 35.9 months, neurological function was improved in 11 patients and in one patient, preoperative status was maintained. No patient experienced tumor recurrence. These findings suggest that CAs should be considered in the differential diagnosis of spinal epidural lesions. Early surgery is advocated to prevent irreversible neurological deficits. When aggravated by a large amount of acute hemorrhage, neurological deterioration is usually acute and prompt surgical decompression is the optimal choice. Because of the excessive vascularity of CAs, en bloc resection is recommended. In addition, a good clinical outcome after GTR can be expected, and the risk of long-term recurrence is low.

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“…Based on these dynamic CT findings, a diagnosis of hepatic hemangioma was established. 8,9) A T3 to T4 laminectomy was performed. Complete decompression of the spinal cord with meticulous hemostasis using bone wax was achieved.…”

Section: Case Reportmentioning

confidence: 99%

Thoracic Vertebral Cavernous Hemangioma in a Schizophrenic Patient -Case Report-

Kurimoto

Noguchi

Nagai

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 55-year-old man presented with gait disturbance, incontinence, and back pain. He had a medical history of schizophrenia for the past 35 years. Computed tomography (CT) and magnetic resonance imaging suggested thoracic vertebral hemangioma. Dynamic CT incidentally detected a hepatic hemangioma. Laminectomy of T3 and T4, resection of the epidural hemangioma, and rigid instrumentation between T1 and T6 using rod and hook systems were performed. Postoperatively, his symptoms completely disappeared and the histological diagnosis was capillary hemangioma. Schizophrenic patients have diminished sensitivity to pain or other symptoms, so neurological symptoms may become severe. However, early and appropriate treatment can result in satisfactory neurological outcome. The patient had a rare association of vertebral hemangioma and hepatic hemangioma, which may be a chance occurrence.

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Spinal Epidural Hemangiomas: Various Types of MR Imaging Features with Histopathologic Correlation

Cited by 68 publications

References 15 publications

Spinal dumbbell-shaped epidural cavernous hemangioma (CM): report of nine surgical cases and literature review

Spinal dumbbell-shaped epidural cavernous hemangioma (CM): report of nine surgical cases and literature review

Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas

Thoracic Vertebral Cavernous Hemangioma in a Schizophrenic Patient -Case Report-

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