Spinal intradural extramedullary haemangioma: MRI and neurosurgical findings

Abstract

Haemangiomas, have rarely been encountered in the spinal intradural extramedullary space and the MRI findings of this entity have been described only in a few cases. We present the Magnetic Resonance Imaging (MRI) and surgical findings of a rare case of intradural extramedullary cavernous angioma located at the T1-T2 level in a 65-year-old man presented progressive paraparesis and upper thoracic back pain. On MRI, a well-circumscribed intradural solid mass, 1 cm in diameter, was detected and another enhancing nodular mass was found at the nerve roots of the cauda equina. The thoracic spinal lesion was removed and the histological diagnosis confirmed cavernous haemangioma. Although very uncommon, haemangioma should be included in the differential diagnosis when a spinal intradural extramedullary lesion is discovered and some neuroradiological findings could allow a presumptive diagnosis.

Multiple Cavernous Angiomas of the Cauda Equina-Case Report-

“…Contrast enhancement, which was observed in five cases (Table 1), has not been emphasized. 3,4,6,8) A previous 5) and our patient presented with acute onset of lumbar pain without subarachnoid hemorrhage (Table 1), which is thought to be secondary to repeated hemorrhage within the tumor. Cavernous angiomas of the cauda equina were strongly adherent to one or more spinal roots, 2,12) which may cause stretching or compression of the roots subsequent to intratumoral microbleeding and result in the acute onset.…”

“…None of the previous 13 cases were multiple (Table 1). [2][3][4][5][6][7][8][9][12][13][14]17) The nine male and four female patients were aged 20 to 67 years (mean 44.7 years). The clinical symptoms were related to compression in six cases, 3,5,6,9,12,13) subarachnoid hemorrhage in four, 2,3,7,17) hydrocephalus in two, 8,14) and asymptomatic in one.…”

“…The clinical symptoms were related to compression in six cases, 3,5,6,9,12,13) subarachnoid hemorrhage in four, 2,3,7,17) hydrocephalus in two, 8,14) and asymptomatic in one. 4) The pathophysiology of the hydrocephalus was not completely understood, as the cerebrospinal fluid protein level was not so increased at 47 mg/dl and 61 mg/dl. 8,14) Possibly the hydrocephalus occurred as a result of recurrent subarachnoid hemorrhage.…”

“…10) Cavernous angiomas occurring in the cauda equina are very rare, with only 13 reported cases. [2][3][4][5][6][7][8][9][12][13][14]17) We present a case of multiple cavernous angiomas of the cauda equina manifesting as low back pain.…”

Supratentorial High Convexity Intradural Extramedullary Cavernous Angioma -Case Report-

“…6) Extramedullary cavernous angiomas are rare, and occur in the intradural extramedullary spaces of the brain or spine such as at the cerebellopontine angle, 3) on the optic chiasm, 2) intracavernously, 4) in the spinal region, 1,5) and others. We present an extremely rare case of cavernous angioma located in the intradural extramedullary space at the supratentorial high convexity.…”