Thoracic Extraosseous Epidural Cavernous Hemangioma

Abstract

Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma.

Pure Spinal Epidural Cavernous Hemangioma: A Case Report

“…A pure epidural cavernous hemangioma was first reported in 1929 by Globus and Doshay. Cavernous hemangiomas are a collection of small capillaries covered with a single layer of endothelium, characterized by lobules, separated by fibrous connective tissue septa, and composed of irregular and dilated vascular channels 4,14) . Cavernous hemangiomas are not real neoplasms.…”

“…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) .…”

“…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) . However, they are hypervascular lesions, so massive bleeding can be seen during the operation.…”

“…However, they are hypervascular lesions, so massive bleeding can be seen during the operation. En-bloc resection after coagulation is preferred 4,6,14) . As in our case, most patients show a good prognosis and an improvement in their symptoms after surgical resection of a cavernous hemangioma 1,4,7,10,12) .…”

Lumbar Epidural Cavernous Hemangioma : A Case Report

“…In the case of angiolipoma, hyperintensity on T1WI can be observed owing to its high fat content. 8,9,[12][13][14][15] Surgical excision is recommended as early as possible because cavernous hemangiomas have a tendency to bleed and grow 9 . Massive bleeding can occur during the operation due to their hyper vascularity.…”