Spinal extradural cavernous haemangioma in an elderly man

Abstract

Cavernous haemangiomas are vascular malformations that may affect any part of the central nervous system. Epidural haemangiomas are rare and constitute ~4% of all epidural tumours and 12% of all intraspinal haemangiomas. These tumours enlarge slowly and produce symptoms of progressive myelopathy or radiculopathy or both. History, clinical examination, routine radiographs, MRI and histopathological studies are the aids for a definitive diagnosis. Surgery can give a very beneficial result with good functional and neurological improvement. Chance of recurrence is less after a good surgical removal. Here we present a case of spinal extradural cavernous haemangioma in a 65- year-old man who had a good functional and neurological recovery after surgery. At 9 months postoperative follow-up, he did well without any new problems with regard to recurrence. We report this case for its rarity.

Primary spinal epidural cavernous hemangioma: clinical features and surgical outcome in 14 cases

“…Based on MRI characteristics, spinal epidural vascular le sions can be categorized into 4 types: arteriovenous type with an organized hematoma, venous type, cavernous type, and cavernous type with hematoma. 10 Digital subtraction angiography (DSA) has no role in the management of epi dural cavernous hemangiomas, 7,12 since these lesions fail to show up on angiography and cannot be embolized; how ever, DSA can be helpful in ruling out other types of spi nal vascular malformations. Arteriovenous malformations usually show flow void signal on MR images due to highvelocity blood flow.…”

“…We failed to achieve a total resection in 2 cases; recurrent tumor seems to be the most important hindrance in achieving total re section, although there are reports that total resection still can be achieved by elaborate microscopic surgery in cases of recurrent epidural cavernous hemangioma. 1,3,12 Complete resection is currently the best treatment for epidural cavernous hemangiomas. 9,17 During surgery, whenever a hypervascular lesion encroaches onto the dura mater with a soft, purple tumor mass extending through the foramen, an epidural cavernous hemangioma should be strongly suspected.…”

“…Pure non-vertebral origin spinal epidural cavernous hemangiomas are relatively rare; so far only about 100 cases have been reported in the literature. 12,14 With the widespread use of MRI, the rate of discovery of spinal epidural hemangiomas has dramatically increased. 6 Due to their tendency to spontaneously and intraopera tively bleed, as well as the probability of recurrence, spi nal epidural hemangiomas should receive more attention from neurosurgeons.…”

A case of spinal epidural venous malformation with mediastinal extension: management with combined surgery and percutaneous sclerotherapy

“…Pure nonvertebral spinal epidural venous malformations are relatively rare, and about 100 cases have been reported in the literature. 25,30 These are particularly rare in the pediatric age group, 29 and are known to occur over a range of 15-79 years of age. 16 The ISSVA classification was updated in April 2014 and has subclassified venous malformations as common, familial cutaneo-mucosal, blue rubber bleb nevus (Bean) syndrome, glomuvenous malformation, cerebral cavernous malformation, and other.…”

“…12,33 A precise preoperative diagnosis based on imaging features is often difficult. Digital subtraction angiography has no role in the management of venous malformations as they are not well visualized and cannot be embolized, 11,25 though digital subtraction angiography can be helpful in ruling out other types of vascular malformations.…”