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Ismaiel N, Ibrahem H, Jabbour G, Joha M, Abdulrahman M, Alshehabi Z. Spinal intradural extramedullary cavernoma: A case report. Int J Surg Case Rep 2024; 115:109274. [PMID: 38219515 PMCID: PMC10826290 DOI: 10.1016/j.ijscr.2024.109274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION Cavernomas are rare vascular lesions that can occur anywhere along the neuraxis. However, they are most commonly found in the cerebral hemispheres. Spinal cavernomas are more uncommon and intradural extramedullary cavernomas are the most uncommon as they constitute only 3 % of spinal cavernomas. PRESENTATION A 36-year-old female presented to our neurosurgical clinic with a history of back pain radiating to the left side of the chest with left lower extremity paresthesia and ataxia without urinary disturbance. Neurological exam showed left-sided hypoesthesia below the T9 dermatome in addition to increased patellar and Achilles reflexes on the left side. MRI showed a homogeneous intradural extramedullary mass which was hyperintense on T1 and hypointense on T2 and it was surgically resected. Pathological examination confirmed the diagnosis of intradural extramedullary cavernoma. DISCUSSION Intradural extramedullary cavernomas are extremely rare lesions that arise within the area located between the inner surface of the dura and the pial surface of the spinal cord. Up until 2022 only 40 cases of intradural extramedullary cavernomas were reported in the literature. MRI is the preferred imaging modality and pathology is the golden standard for diagnosis. Surgical resection showed very promising results and it is considered the golden standard for treating this condition. However, surgery should be performed urgently to give an optimal outcome. CONCLUSION Clinicians should consider this condition in their differential diagnoses when faced with progressive spinal root compression symptoms, sudden onset myelopathy, or progressive subarachnoid hemorrhage.
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Affiliation(s)
- Nahar Ismaiel
- Cancer Research Center, Tishreen University, Latakia, Syria; Faculty of Medicine, Tishreen University, Latakia, Syria.
| | - Hayyan Ibrahem
- Department of Neurosurgery, Tishreen University Hospital, Latakia, Syria
| | - Georges Jabbour
- Department of Neurosurgery, Tishreen University Hospital, Latakia, Syria
| | - Mohamad Joha
- Department of Neurosurgery, Tishreen University Hospital, Latakia, Syria
| | | | - Zuheir Alshehabi
- Cancer Research Center, Tishreen University, Latakia, Syria; Department of Pathology, Tishreen University Hospital, Latakia, Syria
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McQueen SA, Haji FA, Figueroa EL, Sallam Y, Ang LC, Duggal N. Intradural-extramedullary Spinal Cavernoma. Can J Neurol Sci 2023; 50:797-802. [PMID: 36453118 DOI: 10.1017/cjn.2022.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Sydney Amelia McQueen
- MD/PhD Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Faizal Aminmohamed Haji
- Division of Neurosurgery, Department of Surgery, University of British Columbia, British Columbia. Canada
| | - Enriqueta Lucar Figueroa
- Division of Neurosurgery, Department of Clinical Neurological Sciences, Western University, Ontario, Canada
| | - Yasmine Sallam
- Department of Medical Imaging, Northern Ontario School of Medicine, Health Sciences North, Ontario, Canada
| | - Lee Cyn Ang
- Department of Pathology and Laboratory Medicine, Western University, Ontario, Canada
| | - Neil Duggal
- Division of Neurosurgery, Department of Clinical Neurological Sciences, Western University, Ontario, Canada
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Lumbar Spinal nerve root cavernoma: A rare cause of Intradural extramedullary lesion – Case Report. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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D’Onofrio GF, Capo G, Vasiljevic A, Barrey CY. Pure lumbar foraminal cavernous malformation in a patient with Cowden syndrome-a case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:390-396. [PMID: 36285093 PMCID: PMC9547691 DOI: 10.21037/jss-22-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Spinal cavernous malformations (CMs) are slow flow venous vascular malformations which can occur in vertebral body, epidural space or intramedullary. Only 7 cases were described confined in foraminal space. Cowden syndrome (CS) is an autosomal dominant genodermatosis that may present and develop vascular malformations, which include CM. They were found intracranial, and rarely visceral. No association with spinal CM and CS has been reported to date. CASE DESCRIPTION A 46-year-old patient with CS came to our attention with a L5 radiculopathy secondary to a slow-growing intra-foraminal mass lesion, with bony scalloping. The lesion mimicked a schwannoma at radiological imaging and intraoperative findings. En bloc resection with root sacrifice was performed. No excessive bleeding was observed. After surgical resection, anatomical pathology demonstrated a CM. Postoperative review of neuroimaging revealed features compatible with chronic resolved peripheral haemorrage. The patient had no intra- or post-operative complications, and an immediate relief of symptoms was observed. The follow-up spinal magnetic resonance imaging (MRI) obtained 3 months after surgery, demonstrated the total removal of the lesion. CONCLUSIONS CMs can be confined to foraminal space and associated with CS. They may mimic peripheral nerve sheath tumors. Diagnosis may be challenging. No pathognomonic imaging features were found. Complete resection with root sacrifice seems to be a safe and efficient technique.
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Affiliation(s)
- Ginevra Federica D’Onofrio
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon-Bron, France
- Agostino Gemelli Hospital, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon-Bron, France
| | - Alexandre Vasiljevic
- Department of Pathology and Neuropathology, Lyon Civils Hospitals, Lyon-Bron, France
| | - Cédric Y. Barrey
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon-Bron, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, Paris, France
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Rosenblum JS, Wang H, Dmitriev PM, Cappadona AJ, Mastorakos P, Xu C, Jha A, Edwards N, Donahue DR, Munasinghe J, Nazari MA, Knutsen RH, Rosenblum BR, Smirniotopoulos JG, Pappo A, Spetzler RF, Vortmeyer A, Gilbert MR, McGavern DB, Chew E, Kozel BA, Heiss JD, Zhuang Z, Pacak K. Developmental vascular malformations in EPAS1 gain-of-function syndrome. JCI Insight 2021; 6:144368. [PMID: 33497361 PMCID: PMC8021124 DOI: 10.1172/jci.insight.144368] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022] Open
Abstract
Mutations in EPAS1, encoding hypoxia-inducible factor-2α (HIF-2α), were previously identified in a syndrome of multiple paragangliomas, somatostatinoma, and polycythemia. HIF-2α, when dimerized with HIF-1β, acts as an angiogenic transcription factor. Patients referred to the NIH for new, recurrent, and/or metastatic paraganglioma or pheochromocytoma were confirmed for EPAS1 gain-of-function mutation; imaging was evaluated for vascular malformations. We evaluated the Epas1A529V transgenic syndrome mouse model, corresponding to the mutation initially detected in the patients (EPAS1A530V), for vascular malformations via intravital 2-photon microscopy of meningeal vessels, terminal vascular perfusion with Microfil silicate polymer and subsequent intact ex vivo 14T MRI and micro-CT, and histologic sectioning and staining of the brain and identified pathologies. Further, we evaluated retinas from corresponding developmental time points (P7, P14, and P21) and the adult dura via immunofluorescent labeling of vessels and confocal imaging. We identified a spectrum of vascular malformations in all 9 syndromic patients and in all our tested mutant mice. Patient vessels had higher variant allele frequency than adjacent normal tissue. Veins of the murine retina and intracranial dura failed to regress normally at the expected developmental time points. These findings add vascular malformation as a new clinical feature of EPAS1 gain-of-function syndrome. We discovered vascular malformations due to failure of developmental vascular regression in patients with EPAS1 gain-of-function mutation syndrome and the corresponding transgenic mouse model.
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Affiliation(s)
- Jared S Rosenblum
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Herui Wang
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Pauline M Dmitriev
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Anthony J Cappadona
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Panagiotis Mastorakos
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA.,Viral Immunology and Intravital Imaging Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Chen Xu
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA
| | - Nancy Edwards
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Danielle R Donahue
- Mouse Imaging Facility, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Jeeva Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Matthew A Nazari
- Internal Medicine and Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Russell H Knutsen
- Laboratory of Vascular and Matrix Genetics, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Bruce R Rosenblum
- Department of Neurosurgery, Riverview Medical Center, Red Bank, New Jersey, USA
| | - James G Smirniotopoulos
- Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.,National Library of Medicine, Bethesda, Maryland, USA
| | - Alberto Pappo
- Oncology Department, Developmental Biology and Solid Tumor Program, St. Jude Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital, and Medical Center, Phoenix, Arizona, USA
| | - Alexander Vortmeyer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Dorian B McGavern
- Viral Immunology and Intravital Imaging Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Beth A Kozel
- Laboratory of Vascular and Matrix Genetics, National Heart Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - John D Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Zhengping Zhuang
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA
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Vicenty JC, Fernandez-de Thomas RJ, Estronza S, Mayol-Del Valle MA, Pastrana EA. Cavernous Malformation of a Thoracic Spinal Nerve Root: Case Report and Review of Literature. Asian J Neurosurg 2019; 14:1033-1036. [PMID: 31497159 PMCID: PMC6702987 DOI: 10.4103/ajns.ajns_249_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intradural extramedullary spinal cavernous malformations (CMs) remain the least common variant of these lesions and can originate from the inner surface of the dura mater, the pial surface of the spinal cord, and the blood vessels in the spinal nerves. Root-based-only extramedullary CMs are very rare in the thoracic region with only four cases reported. We present a case of 56-year-old male with 1-year progression of lower extremities weakness. Magnetic resonance imaging demonstrated a hyperintense lesion in the upper thoracic region. Surgical exploration revealed a CM with origin in the second thoracic nerve root with gross total resection. Histopathological examination confirmed a CM. The patient had complete recovery of neurological function at 3 months interval. Intradural extramedullary CM is extremely rare entity that must be considered in the differential diagnosis of intradural extramedullary lesions. Surgical resection is the treatment of choice to prevent further neurological damage.
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Affiliation(s)
- Juan C Vicenty
- Department of Surgery, Neurosurgery Section, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Ricardo J Fernandez-de Thomas
- Department of Surgery, Neurosurgery Section, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Samuel Estronza
- Department of Surgery, Neurosurgery Section, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Miguel A Mayol-Del Valle
- Department of Surgery, Neurosurgery Section, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Emil A Pastrana
- Department of Surgery, Neurosurgery Section, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
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Pétillon P, Wilms G, Raftopoulos C, Duprez T. Spinal intradural extramedullary cavernous hemangioma. Neuroradiology 2018; 60:1085-1087. [PMID: 30090980 DOI: 10.1007/s00234-018-2073-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Abstract
Spinal intradural extramedullary cavernous hemangiomas are very rare. Mixed intensities on T1- andT2-weighted images due to repeated hemorrhages and poor to absent contrast-enhancement are the most common imaging features of the disease allowing accurate differentiation from the far more frequent meningiomas and schwannomas of similar location.
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Affiliation(s)
- Philippe Pétillon
- Cliniques Universitaires Saintt-Luc (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Guido Wilms
- Cliniques Universitaires Saintt-Luc (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium. .,Department of Radiology, UZLeuven Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Christian Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saintt-Luc (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
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Oishi T, Sakai N, Sameshima T, Kawaji H, Namba H. The efficacy of resection of an intradural extramedullary foramen magnum cavernous malformation presenting with repeated subarachnoid hemorrhage: a case report. J Med Case Rep 2017; 11:63. [PMID: 28274277 PMCID: PMC5343320 DOI: 10.1186/s13256-017-1220-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/29/2017] [Indexed: 11/27/2022] Open
Abstract
Background Intradural extramedullary cavernous angiomas of the central nervous system are a rare type of cavernous angioma, but they can cause fatal subarachnoid hemorrhage. The efficacy of resection for this type of cavernous malformations remains uncertain. This is the first report to recommend surgical resection of these types of lesions regardless of the fatal condition. Case presentation Our patient was a 70-year-old Japanese man who experienced a sudden onset of an occipital headache, followed by bilateral abducens nerve palsy. Magnetic resonance imaging revealed a small amount of hemorrhage in both of the lateral ventricles and an intradural extramedullary mass lesion in the left side of his foramen magnum. Two weeks after the appearance of initial symptoms, he became comatose. A computed tomography scan showed an increase in the subarachnoid intraventricular hemorrhaging and of the acute hydrocephalus. Following ventricular drainage, total tumor resection was performed using the lateral suboccipital transcondylar approach in conjunction with a first cervical hemilaminectomy. We observed a grape-like vascular-rich tumor with calcification that was adhering tightly to the wall of his left vertebral artery. A histopathological examination of the surgery specimen identified it as a cavernous angioma. After placement of a ventriculoperitoneal shunt and 2 months of rehabilitation, he recovered completely. Conclusions An intradural extramedullary foramen magnum cavernous malformation is quite rare. The fragile surface of our patient’s lesion was causing repeated subarachnoid hemorrhage and consequently progressive fatal neurological deterioration. Surgical resection of the lesion to prevent repeated hemorrhage was performed and he recovered fully. Therefore, we recommend surgical resection of the lesion regardless of the potentially fatal condition.
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Affiliation(s)
- Tomoya Oishi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Naoto Sakai
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroshi Kawaji
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
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Baldvinsdóttir B, Erlingsdóttir G, Kjartansson Ó, Ólafsson IH. Extramedullary Cavernous Hemangioma with Intradural and Extradural Growth and Clinical Symptoms of Brown-Séquard Syndrome: Case Report and Review of the Literature. World Neurosurg 2016; 98:881.e5-881.e8. [PMID: 27867117 DOI: 10.1016/j.wneu.2016.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Primary spinal tumors are rare. Symptoms depend on the size and location of the tumor. CASE DESCRIPTION A patient presented with a rare clinical finding, Brown-Séquard syndrome. The symptoms were caused by an extramedullary tumor compressing on the thoracic spinal cord. Pathologic examination showed cavernous hemangioma with growth both intradurally and extradurally. CONCLUSIONS This is an extremely rare finding; to our knowledge, only 1 case report has been published before in which a spinal cavernous hemangioma had intradural and extradural growth. The clinical symptoms of Brown-Séquard syndrome have not been described before in the findings of spinal cavernous hemangiomas.
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Affiliation(s)
| | - Gígja Erlingsdóttir
- Department of Pathology, Landspítali University Hospital, Reykjavík, Iceland
| | - Ólafur Kjartansson
- Department of Radiology, Landspítali University Hospital, Reykjavík, Iceland
| | - Ingvar Hákon Ólafsson
- Department of Neurosurgery, Landspítali University Hospital, Reykjavík, Iceland; Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Mataliotakis G, Perera S, Nagaraju S, Marchionni M, Tzerakis N. Intradural extramedullary cavernoma of a lumbar nerve root mimicking neurofibroma. A report of a rare case and the differential diagnosis. Spine J 2014; 14:e1-7. [PMID: 25200326 DOI: 10.1016/j.spinee.2014.08.447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/16/2014] [Accepted: 08/18/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intradural extramedullary (IDEM) cavernomas are rare vascular malformations. They are well-circumscribed dark berry-like lesions with a histologic appearance of sinusoidal vascular channels. Neurofibromas are the most common IDEM tumors, originating from all nerve elements and leading to firm enlargement of the affected nerve root. These lesions are completely different; however, they may involve the spinal nerve roots or the major nerve trunks. Any similarities in clinical findings are based on different pathophysiology. PURPOSE To present a rare resemblance of an IDEM cavernoma to a neurofibroma. STUDY DESIGN This is a case report with review of the literature focused on the differential diagnosis. METHODS A 79-year-old patient presented with acute sensorimotor disturbance from L2-S1 levels. The investigations showed an L2-L3 lesion occupying the canal. Findings resembled a neurofibroma and a surgical resection was decided. RESULTS The complete surgical resection revealed a vascular lesion originating from a nerve root. The histology confirmed an IDEM cavernoma. This is a unique case as such a clinical resemblance and a macroscopical appearance has not been reported for an IDEM cavernoma as yet. The patient showed full postoperative recovery from his initial symptoms. CONCLUSIONS Intradural extramedullary cavernoma is a rare cause of compression to spinal cord or nerve roots. Its manifestation characteristics are well defined and should always be part of the differential diagnosis. Intraoperative findings aid the diagnosis in nontypical cases before the final histology. The nontraumatic and nerve tissue sparing surgical resection warrants optimal postoperative results and excellent prognosis.
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Affiliation(s)
- George Mataliotakis
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
| | - Stravinsky Perera
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
| | - Santhosh Nagaraju
- Pathology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK
| | - Marco Marchionni
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
| | - Nikolaos Tzerakis
- Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK
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Yang T, Wu L, Yang C, Deng X, Xu Y. Cavernous angiomas of the cauda equina: clinical characteristics and surgical outcomes. Neurol Med Chir (Tokyo) 2014; 54:914-23. [PMID: 25367585 PMCID: PMC4533342 DOI: 10.2176/nmc.oa.2014-0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cavernous angioma (CA) is a rare hamartomatous vascular lesion, consisting of abnormal, dilated, and packed sinusoidal vascular channels without interposed nervous tissue. CAs of the cauda equina are exceedingly rare and have been previously reported in the literature as case reports. The aim of this study was to discuss the clinical presentation and the outcomes of microsurgery for these rare lesions. We retrospectively reviewed the records of 10 patients who underwent microsurgery for CAs of the cauda equina. All patients had performed pre- and postoperative magnetic resonance imaging (MRI). CAs of the cauda equina generally exhibited mixed intensity on T1- and T2-weighted images. Contrast-enhanced T1-weighted images showed heterogeneous enhancement. The hemosiderin ring which surrounded the cauda equina CA was rare. Gross total resection was achieved in all cases. All patients were followed up, with a mean duration of 41.1 months. Long-term neurological function was improved in nine patients and remained stable in one patient. No recurrence was observed on MRI. CAs should be considered in the differential diagnosis of cauda equina tumors. Because of the excessive vascularity of CAs, en bloc resection is recommended. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University
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12
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Popescu M, Titus Grigorean V, Julieta Sinescu C, Dumitru Lupascu C, Popescu G, Mihaela Sandu A, Emil Plesea I. Cauda equina intradural extramedullary cavernous haemangioma: case report and review of the literature. Neurol Med Chir (Tokyo) 2013; 53:890-5. [PMID: 24097094 PMCID: PMC4508733 DOI: 10.2176/nmc.cr2012-0309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cavernous haemangioma (cavernoma) is a benign vascular lesion, exceptionally located in cauda equina. We report a case, diagnosed and operated in the Department of Neurosurgery from Pitesti County Emergency Hospital, of a 60-year-old woman with history of lumbar region distress, who presented with low back pain, paravertebral muscle contracture, and bilateral lumbar radiculopathy, with sudden onset after lifting effort. The preoperative diagnosis was done using computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery-two level laminectomy, dural incision, and tumor dissection from the cauda equina nerve roots under operatory microscope. Histopathological examination confirmed the positive diagnosis of cavernoma of cauda equina. The patient's outcome was favorable, without postoperative neurological deficits.
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Affiliation(s)
- Mihai Popescu
- Department of Neurosurgery, Emergency County Hospital
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13
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Killeen T, Czaplinski A, Cesnulis E. Extradural spinal cavernous malformation: A rare but important mimic. Br J Neurosurg 2013; 28:340-6. [DOI: 10.3109/02688697.2013.841858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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14
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Cho WS, Kim KJ, Kwon OK, Kim CH, Kim J, Han MH, Chung CK. Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformations. J Neurosurg Spine 2013; 19:207-16. [DOI: 10.3171/2013.4.spine12732] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Object
Spinal vascular diseases, such as spinal dural arteriovenous fistulas (DAVFs), perimedullary arteriovenous fistulas (AVFs), and spinal arteriovenous malformations (AVMs), are very rare. The authors analyzed the features and treatment outcomes of these conditions.
Methods
Data from 64 patients were retrospectively reviewed. There were 33 spinal DAVFs (1 patient had 2 lesions), 20 perimedullary AVFs, and 12 spinal AVMs. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated according to the diseases, subtypes, and treatment modalities. The median duration of follow-up was 20, 42, and 56 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively.
Results
Spinal DAVFs showed faster progression of symptoms (median 5, 12, and 36 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively) and worse neurological status at diagnosis (poor neurological status in 56%, 65%, and 33%, respectively). On MRI, signal voids were demonstrated in all except 1 spinal DAVF. At the last follow-up, 94% of spinal DAVFs, 68% of perimedullary AVFs, and 50% of spinal AVMs were completely obliterated. Favorable clinical outcomes were achieved in 91%, 95%, and 58%, respectively. In detail, the majority (78%) of spinal DAVFs were embolized, resulting in complete obliteration in 92% and favorable clinical outcomes in 92%. Most Type IVa and IVb perimedullary AVFs were surgically treated (71% and 88%), with complete obliterations of 86% and 71%, and favorable clinical outcomes in 100% and 86%, respectively. All Type IVc lesions were embolized with a low cure rate of 40%; however, clinical outcomes were satisfactory. Spinal AVMs were generally embolized (67%), and only glomus-type lesions attained a satisfactory cure rate (80%) and clinical outcome (100%).
Conclusions
Embolization produced satisfactory outcomes in spinal DAVFs and glomus-type spinal AVMs. Surgery is advantageous in Type IVa and IVb perimedullary AVFs. Palliative embolization can be effective in Type IVc perimedullary AVFs and juvenile spinal AVMs.
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Affiliation(s)
- Won-Sang Cho
- 1Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do
| | - Ki-Jeong Kim
- 4Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - O-Ki Kwon
- 4Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Jiha Kim
- 1Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do
| | - Moon Hee Han
- 2Departments of Neurosurgery and
- 3Radiology, Seoul National University Hospital, Seoul; and
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15
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Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. SUMMARY OF BACKGROUND DATA Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location. METHODS We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS). RESULTS A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%). CONCLUSION Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas.
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16
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Jin YJ, Chung SB, Kim KJ, Kim HJ. Spinal intradural extramedullary cavernoma presenting with intracranial superficial hemosiderosis. J Korean Neurosurg Soc 2011; 49:377-80. [PMID: 21887400 DOI: 10.3340/jkns.2011.49.6.377] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/09/2010] [Accepted: 05/30/2011] [Indexed: 11/27/2022] Open
Abstract
A case of intradural extramedullary cavernous angioma is presented with headache, dizziness, and bilateral sensorineural hearing loss caused by an intracranial superficial hemosiderosis. It was incidentally found in a patient with a 3-month history of sustained headache, dizziness and a 3-year history of hearing difficulty. The neurological examination was unremarkable in the lower extremity. MR images showed an intracranial superficial hemosiderosis mostly in the cerebellar region. Myelography and MR images of the thoracolumbar spine revealed an intradural extramedullary mass, which was pathologically proven to be a cavernous angioma. T12 total laminoplastic laminotomy and total tumor removal were performed without any neurologic deficits. The patient's symptoms, including headache and dizziness, have been absent for three years. Intradural extramedullary cavernous angioma can present with an intracranial superficial hemosiderosis as a result of chronic subarachnoid hemorrhage.
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Affiliation(s)
- Yong Jun Jin
- Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea
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17
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Khalatbari MR, Hamidi M, Moharamzad Y, Taheri B. Cauda equina cavernous angioma presenting as acute low back pain and sciatica. A report of two cases and literature review. Neuroradiol J 2011; 24:636-42. [PMID: 24059723 DOI: 10.1177/197140091102400421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 04/26/2011] [Indexed: 11/17/2022] Open
Abstract
Spinal cavernous angiomas are rare vascular lesions occurring mainly in the vertebral bodies extending secondary into the extradural space. Only 3% of these lesions are intradural, usually localized within the spinal cord. Rarely, cavernous angioma has been reported to occur in the cauda equina. We describe clinical, diagnostic imaging, and surgical procedures of two cases of cavernous angioma of the cauda equina who presented with acute back pain and sciatica. The relevant literature is also reviewed.
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Affiliation(s)
- M R Khalatbari
- Department of Neurosurgery, Arad Hospital; Tehran, Iran -
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18
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Chun SW, Kim SJ, Lee TH, Koo HS. Intra-root cavernous angioma of the cauda equina : a case report and review of the literature. J Korean Neurosurg Soc 2010; 47:291-4. [PMID: 20461171 DOI: 10.3340/jkns.2010.47.4.291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/01/2009] [Accepted: 03/22/2010] [Indexed: 11/27/2022] Open
Abstract
Authors experienced intra-root cavernous angioma which is very rare case among cavernous angiomas of cauda equina. Our intra-root cavernous angioma was confirmed by findings from operating field and microscopic examination. We report this case with review of the literature.
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Affiliation(s)
- Sang Woo Chun
- Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
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