Acute presentation of spinal epidural cavernous angiomas: case report

Lumbar Epidural Cavernous Hemangioma: A Case Report and Review of the Literature

Pure epidural cavernous hemangioma (ECH) of the spine are rare and account for only 4% of all epidural spinal lesions. We report a case of epidural cavernoma at L3/4 presenting with L4 radiculopathy. Radiological, intraoperative findings and histopathology are presented. We present the case of a 56-year-old man who was admitted with a right L4 radiculopathy including an M4 paresis of the right leg, hypoesthesia L4, and radicular pain. Magnetic resonance imaging (MRI) confirmed an extradural lesion L3/4 partially expanding into the right intervertebral foramen. The lesion had a heterogeneous signal, isointense on T1-weighted and hyperintense on proton density (PD) and T2-weighted images. At surgery, an epidural, ovoid, gray-red, soft mass, lightly adherent to the dura and extending to the right L4 foramen was observed. Findings in the histological examination indicated a cavernous hemangioma without signs of hemorrhage. Symptoms and paresis improved rapidly after surgery. The follow-up MRI showed complete resection of the lesion with no signs of radicular compression. Spinal ECH should be considered as a cause of chronic lumbar radiculopathy with atypical radiological findings. Early diagnosis and total removal of the spinal ECH might prevent hemorrhage and neurological deficits. Fewer than 50 cases of lumbar epidural spinal hemangioma have been reported until today, and our case report is adding valuable knowledge to the existing literature.

Spinal Epidural Cavernous Hemangiomas: A Clinical Series of 9 Cases and Literature Review

Objective

Spinal epidural cavernous hemangiomas are very rare vascular lesions and are, therefore, seldom reported and easily misdiagnosed. Herein, we present a series of 9 cases with spinal epidural cavernous hemangiomas and discuss their pathogenesis, clinical characteristics, radiological findings, differential diagnosis, surgical interventions, pathological characteristics, and prognosis.

Methods

We retrospectively retrieved and analyzed the data of patients with pure epidural cavernous hemangiomas, who underwent spinal magnetic resonance imaging, and surgical intervention at the First Hospital of Jilin University, China, between January 2005 and December 2019. The data on patients’ clinical manifestations, imaging characteristics, surgical intervention, histopathological findings, and postoperative follow-up were also recorded and analyzed.

Results

In all, 5 men and 4 women with the mean age of 61 years (range, 41–78 years) were recruited. All patients experienced a gradual onset of symptoms and a slowly progressive clinical course, and no patient presented an acute onset of symptoms. The clinical manifestations include myelopathic signs in 8 patients (88.9%) and radicular symptoms in 3 patients (33.3%). On T1-weighted imaging, 6 lesions appeared isointense (55.6%), and 4 lesions exhibited hypointense (44.4%) signals. On T2-weighted imaging, 8 lesions appeared hyperintense (88.9%), and 1 lesion was heterogeneously intense (11.1%). Following gadolinium administration, 5 lesions appeared homogeneous with significant enhancement (55.6%), 1 lesion was homogeneous and mild enhancement (11.1%), and 3 lesions were heterogeneous with mild enhancement (33.3%). All patients received early microsurgery assisted by intraoperative electrophysiologic monitoring and neuronavigation in the lateral position via the posterior midline approach. Five patients underwent total laminectomy (55.6%), and 4 underwent hemilaminectomy (44.4%). Total excision was achieved in all cases. The average follow-up period was 55.1 months (ranging 10–123 months). All patients exhibited significant clinical improvement of their neurological deficits and achieved a favorable outcome with no recorded recurrence at last follow-up.

Conclusions

Spinal epidural cavernous hemangiomas are rare vascular malformations. Early surgical treatment with total resection is an optimum treatment, particularly for patients with an acute exacerbation onset. The prognosis is mostly good and depends predominantly on the severity of the preoperative status.

Clinical features and long-term surgical outcomes of pure spinal epidural cavernous hemangioma-report of 23 cases

BACKGROUND

Pure spinal epidural cavernous malformation (CM) is a rare hypervascular disease that is easily misinterpreted as other imaging-similar epidural lesions. The demographic characteristics, therapeutic strategies, and surgical outcomes associated with this vascular entity remains unclear.

METHODS

A retrospective review of patients with pathologically proven, pure epidural CM from 2001 to 2018 was conducted. All data that included clinical manifestations, radiographic features, and treatment modalities were analyzed.

RESULTS

Twenty-three consecutive patients with an average age of 51.5 ± 8.4 years old (range 38-70 years old) were included; of these, 52.2% were female patients. Clinical manifestation included chronic progressive nerve root disturbance syndrome in 7 patients (30.4%) and myelopathy in 16 patients (69.6%). The CM level was predominately thoracic (n = 14, 60.9%) or lumbar (n = 6, 26.1%), with the dorsal epidural space (n = 14, 60.9%) the most common site. The initial clinical diagnoses were schwannoma (n = 11, 52.2%), meningioma (n = 5, 21.7%), angioma (n = 3, 13.1%), recurrent CMs (n = 2, 8.7%), and metastatic tumor (n = 1, 4.3%). Fifteen lesions (65.2%) were isointense on T1-weighted images, and all lesions were hyperintense on T2-weighted images, with homogenously strong enhancement observed in 17 lesions (73.9%). Total resection was achieved in 18 patients (78.3%) and usually resulted in excellent clinical outcomes (n = 21, 91.3%). No patients experienced recurrence of symptoms, and lesion relapse during follow-up.

CONCLUSION

Total surgical removal of epidural CM can usually achieve satisfactory outcomes in patients with a chronic clinical course and should be recommended. Subtotal removal of tumors can also benefit patients, and guaranteed a long recurrent free time after surgery. A good preoperative neurological condition usually leads to good outcomes.

Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas

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.

Spinal Cavernomas: Outcome of Surgically Treated 10 Patients

Aim

We report the preoperative and postoperative findings and also neurological follow-up results from 10 spinal cavernoma patients treated in our clinic. Several representative cases are presented in terms of clinical features, imaging results, and surgical outcomes.

Material and methods

The data were retrospectively collected from patients' files in the hospital records and sorted with regards to clinical presentation, radiologic features, and operative findings. Patients received spinal MRI scans for the diagnosis of spinal cavernomas (SC) and postsurgical evaluation. Clinical presentation was evaluated via Ogilvy classification and symptoms were checked preoperatively and postoperatively at third month and first year using McCormick scale. Primary treatment was microsurgical operation aiming a gross total lesion resection.

Results

10 spinal cavernoma patients between the ages 30 and 63 were treated. Six (60%) of the patients were diagnosed with cervical and four (40%) others were diagnosed with thoracic SC. Among the patient group, mean preoperative Ogilvy classification score was 2.3 ± 0.7.8 and McCormick score was 1.9 ± 0.7. There was no residual mass or relapse after surgery. One patient developed surgery-related left hemiparesis, which was normalized at 1 year follow-up.

Conclusion

Patients must be diagnosed with MRI since it is nowadays a gold standard. Preoperative and postoperative scores are important in evaluating the patients' condition and improvement. The results from our patient series also reinforce the notion that immediate surgery should be the preferred treatment method for cavernomas. Intraoperative neurophysiologic monitarization should assist the surgery in order to prevent complications. In conclusion, microsurgery is a gold standard method that we recommend for cases of cavernomas, which will not recur if gross total resection is achieved.

Spinal epidural capillary hemangioma: A rare case report with a review of literature

Background:

Purely epidural capillary hemangiomas are very rare. There are only 6 such reports.

Case Description:

A 50-year-old male presented with a progressive lower extremity paraparesis. Magnetic resonance imaging demonstrated a purely epidural lesion at the L1-L2 level without any bony involvement. Following an L1-L2 laminectomy for total excision of the lesion, the patient showed significant improvement. The histopathology was consistent with a pure capillary hemangioma.

Conclusion:

The radiological presentation of purely epidural capillary hemangiomas are often similar to those of schwannomas and meningiomas. Surgical confirmation of the pathology, and gross total excision of these lesions is recommended.

Spinal epidural cavernous hemangioma: case report

Pure epidural cavernous hemangiomas are quite rare. In this paper, a case of lumbar epidural cavernous hemangioma presenting as a lumbar radiculopathy is presented. The magnetic resonance imaging findings, differential diagnosis and therapy options of this rare case are discussed.

A purely extradural lumbar nerve root cavernoma mimicking acute myeloid leukemia recurrence: Case report and literature review

BACKGROUND

Myeloid sarcoma (MS) is a malignant tumor that usually occurs concomitantly with or following acute myeloid leukemia (AML). Cavernomas are benign congenital malformations that are unusual in the spine and exceedingly rare in pure extradural locations.

CASE DESCRIPTION

We report a 73-year-old female with a previous medical history of AML in remission for 3 years who presented with symptoms of low back pain and right lower extremity radiculopathy. A magnetic resonance scan showed an extradural, foraminal lesion centered at the L2 level involving the right L2 nerve root. In view of the history of AML, this lesion was potentially considered MS, a form of AML relapse. Surgery consisting of a right L1 and L2 hemilaminectomy facilitated gross total resection of the purely extradural lesion the proved histologically to be a cavernoma.

CONCLUSION

In patients with a history of leukemia, MS must be considered in the differential diagnosis for any epidural or nerve root lesion that appears following treatment. Although rare, cavernomas must be considered among the differential diagnoses for epidural nerve root lesions in the setting of AML.

Large, spontaneous spinal subdural-epidural hematoma after epidural anesthesia for caesarean section: Conservative management with excellent outcome

Background:

Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively.

Case Description:

A 38-year-old woman came to the emergency department (ED) complaining of severe neck and back pain. She had undergone a caesarean section under epidural anesthesia 4 days prior to her arrival in the ED. She was placed on heparin and then warfarin to treat a pulmonary embolism that was diagnosed immediately postpartum. Her neurological examination at presentation demonstrated solely the existence of clonus in the lower extremities and localized cervical and low thoracic pain. In the ED, the patient's international normalized ratio was only mildly elevated. Spinal magnetic resonance imaging revealed a large thoracolumbar subdural hematoma with some epidural components in the upper thoracic spine levels. Spinal cord edema was also noted at the T6-T7 vertebral level. The patient was admitted to the neurosurgical intensive care unit for close surveillance and reversal of her coagulopathy. She was treated conservatively with pain medication, fresh frozen plasma, and vitamin K. She was discharged off of warfarin without any neurological deficit.

Conclusions:

Conservative management of spinal hematomas secondary to induced coagulopathies can be effective. This case suggests that, in the face of neuroimaging findings of significant edema and epidural blood, the clinical examination should dictate the management, especially in such complicated patients.

Pure spinal epidural cavernous hemangioma: A case series of seven cases

INTRODUCTION

Pure spinal epidural cavernous hemangiomas (PSECHs) are rare vascular lesions with about 100 cases reported. Herein, we present a case series of 7 PSECHs discussing their clinical presentation, radiological characteristics, surgical technique and intraoperative findings, pathological features, and functional outcome.

MATERIALS AND METHODS

We retrieved from the retrolective databases of the senior authors, patients with pathologically confirmed PSECH operated between January 2002 and November 2015. From their medical records, the patients' sociodemographic, clinical, radiological, surgical, and histopathological data were retrieved and analyzed.

RESULTS

The mean age of the seven cases was 50.3 years. Four were females. All the five cases (71.4%) in the thoracic spine had myelopathy and the 2 (28.6%) lumbar cases had sciatica. Local pain was present in all the cases. All the lesions were isointense on T1-weighted images, hyperintense on T2-weighted images, and in five cases there was strong homogeneous enhancement. In six cases (85.7%), classical laminectomy was done; lesions resected in one piece in five cases. Total excision was achieved in all the cases. Lesions were thin-walled dilated blood vessels, lined with endothelium, and engorged with blood and with scanty loose fibrous stroma. The median follow-up was 12 months (range: 1-144 months). All patients gradually improved neurologically and achieved a good outcome with no recurrence at the last follow-up.

CONCLUSION

PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.

Solitary spinal epidural cavernous haemangiomas as a rare cause of myelopathy

Cavernous haemangiomas rarely occur in the spinal epidural space. We report the case of a 27-year-old man who presented with myelopathy secondary to spinal cord compression from a purely epidural lesion. The imaging characteristics of cavernous haemangiomas are unique, reflecting a highly vascular lesion. Key differentiating features from intracranial or intramedullary lesions include the lack of a surrounding hemosiderin ring and popcorn appearance. An urgent referral to a neurosurgeon is recommended given the possibility of acute neurological deterioration from intralesional haemorrhage, and good recovery from early surgical resection. Preoperative planning with thorough patient counselling and availability of matched blood is important, and an en bloc resection approach should be taken to minimise blood loss. In this case, the patient experienced complete recovery after surgical resection. No recurrence after complete resection has been reported in the literature. This suggests a good long-term outcome for the patient and that no early adjuvant therapy is necessary.

Pure spinal epidural cavernous hemangioma with intralesional hemorrhage: a rare cause of thoracic myelopathy

Although cavernous hemangiomas occur frequently in the intracranial structures, they are rare in the spine. Most of spinal hemangiomas are vertebral origin and "pure" epidural hemangiomas not originating from the vertebral bone are very rare. Our spinal hemangioma case is extremely rare because of its "pure" epidural involvement and intralesional hemorrhage. A 64-year-old man presented with progressive paraparesis from two months ago. His motor weakness was rated as grade 4/5 in bilateral lower extremities. He also complained of decreased sensation below the T4 sensory dermatome, which continuously progressed to the higher dermatome level. Magnetic resonance imaging demonstrated thoracic spinal tumor at T3-T4 level. The tumor was located epidural space compressing thoracic spinal cord ventrally. The tumor was not involved with the thoracic vertebral bone. We performed T3-5 laminectomy and removed the tumor completely. The tumor was not infiltrating into intradural space or vertebral bone. The histopathologic study confirmed the epidural tumor as cavernous hemangioma. Postoperatively, his weakness improved gradually. Four months later, his paraparesis recovered completely. Here, we present a case of pure spinal epidural cavernous hemangioma, which has intralesional hemorrhage. We believe cavernous hemangioma should be included in the differential diagnosis of the spinal epidural tumors.

Clinical and radiological presentation of spinal epidural haemangiomas: clinical series in a tertiary care centre during a 10-year period

PURPOSE

Haemangiomas are very frequent benign spinal tumours. However, pure epidural location is extremely rare. At present, only 52 cases have been reported in the literature during the last 10 years. We proposed to analyse clinical and radiological features of this rare entity treated in a tertiary care centre over the last 10 years.

METHODS

A study of a retrospective surgical series (2002-2012) was conducted. The clinic's electronic database was searched for "spinal" and/or "vertebral haemangiomas", which were treated by surgery and/or vertebroplasty. Clinical, radiological and histopathological data were analysed.

RESULTS

In total, the series comprised 30 spinal haemangiomas. There were 6 epidural (20 %), 17 vertebral (57 %) and 7 intradural lesions (23 %). There were four men and two women, mean age 28.3 years, with epidural lesions. One patient presented with localised back pain only, two with radiculopathy and focal neurological deficit, two with radiculopathy only and one with isolated focal neurological deficit, respectively. The onset of symptoms was progressive in four cases over weeks to months and sudden in two cases. Preoperative MRI imaging revealed features of meningioma, neurinoma or metastasis.

CONCLUSION

Epidural haemangiomas are extremely rare spinal lesions. They may mimic more common spinal tumours clinically and radiologically. The usual treatment is gross total resection confirming the diagnosis histologically.

Spinal epidural arteriovenous hemangioma mimicking lumbar disc herniation

A spinal epidural hemangioma is rare. In this case, a 51 year-old female patient had low back pain and right thigh numbness. She was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little-known radiological findings. Because there are no effective diagnostic tools to verify the hemangioma, more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions).

Solitary spinal epidural cavernous angioma: report of nine surgically treated cases and review of the literature

PURPOSE

We intend to report the largest series of spinal epidural cavernomas (SEC), discuss their clinical features, imaging characteristics, surgical findings, outcome analysis and compare them with similar reports in the literature.

METHODS

Among the cases of spinal tumors treated surgically by the authors, there have been nine cases of SEC's. All the data were collected prospectively and the cases have been followed after surgery up to the time of this analysis.

RESULTS

There were six female and three male patients with the ages ranging between 13 and 74 years. The lesions were located in the thoracic spine (4 cases), lumbar spine (4 cases) and one at the sacral level. Clinical presentations included acute spinal pain and paraparesis in two, low back pain and radiculopathy in five, and slowly progressive myelopathy in the other two cases. The lesion was iso-intense with the spinal cord in T1W images and hyperintense in T2W images and showed strong homogeneous enhancement after contrast medium injection in most of our cases. In the presence of hemorrhage inside the lesion, it was hyperintense in both T1W and T2W MR sequences as in our case 6. In the single case presenting with acute hemorrhage, epidural hematoma was the only finding, our case 1. Complete surgical removal was achieved in all our cases, and confirmed by postoperative MRI.

CONCLUSION

SEC is hard to be differentiated from other epidural spinal lesions before intervention but should be considered in the list of differential diagnosis regarding its favorable outcome.

Pure spinal epidural cavernous hemangioma

BACKGROUND

Pure epidural cavernous hemangiomas without bony involvement are rare, representing 4% of all spinal epidural tumors. Most of these are case reports and are easily misdiagnosed.

METHODS

Herein nine patients (male:female, 5:4, average age: 51 years) with symptomatic pure epidural spinal cavernous hemangioma between 2005 and 2011 were treated, and the clinical, radiological, and pathological records, treatment, and prognosis were discussed.

RESULTS

All patients experienced a slowing progressive clinical course, except for one with intralesional hemorrhage. Clinical manifestations included back or radiating pain, sensorimotor deficits, and sphincters disturbance. Eight lesions were isointense on T1- and hyperintense on T2-weighted images with homogenously strongly enhancement and one was mixed signal with heterogeneous enhancement because of intratumoral hemorrhage. Hemilaminotomoy or laminotomy was performed and total resection was achieved. All patients experienced a gradual neurological improvement with no recurrence.

CONCLUSIONS

Spinal epidural cavernous hemangioma is a benign vascular malformation that should be excluded in the diagnosis of epidural lesion. Total surgical resection is recommended and usually results in a good prognosis.

Spinal and paraspinal giant cervical cavernous malformation with postpartum presentation

Cavernous malformations (CMs) are found throughout the CNS but are relatively uncommon in the spine. In this report, the authors describe a giant CM with the imaging appearance of an aggressive, invasive, expansive tumor in the cervical spine. The intradural extramedullary portion of the tumor originated from a cervical nerve root; histologically, the lesion was identified as an intraneural CM. Most of the tumor extended into the paraspinal tissues. The tumor was also epidural, intraosseous, and osteolytic and had completely encased cervical nerve roots, peripheral nerves, branches of the brachial plexus, and the vertebral artery on the right side. It became symptomatic during the puerperal period. Gross-total resection was achieved using staged operative procedures, complex dural reconstruction, spinal fixation, and fusion. Clinical, radiographic, and histological details, as well as a discussion of the relevant literature, are provided.

A Case of a Spinal Epidural Capillary Hemangioma: Case Report

BACKGROUND AND IMPORTANCE:

Spinal hemangiomas usually arise from the vertebral body. Epidural hemangiomas are rare lesions, and most reported cases are cavernous. We report a case of a capillary hemangioma in the thoracic epidural space.

CLINICAL PRESENTATION:

The 57-year-old male patient initially presented with low thoracic spine pain. A magnetic resonance image of the thoracolumbar spine demonstrated an avidly enhancing epidural mass lesion in the lower thoracic spine with extension into the adjacent foramina at 2 levels on the right side. The patient developed progressive myelopathy over the course of 2.5 years despite minimal radiological changes. Surgical treatment resulted in good recovery. Histopathologically, the lesion corresponded to a vascular tumor composed of vessels of various calibers with fibrous septa between them.

CONCLUSION:

Early treatment of this type of lesion should be advocated to prevent deterioration and permanent neurological deficits. Appropriate treatment appears to be gross total resection.

Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy

Pure spinal epidural cavernous angiomas are extremely rare lesions, and their normal shape is that of a fusiform mass in the dorsal aspects of the spinal canal. We report a case of a lumbo-sacral epidural cavernous vascular malformation presenting with acute onset of right-sided S1 radiculopathy. Clinical aspects, imaging, intraoperative findings, and histology are demonstrated. The patient, a 27-year-old man presented with acute onset of pain, paraesthesia, and numbness within the right leg corresponding to the S1 segment. An acute lumbosacral disc herniation was suspected, but MRI revealed a cystic lesion with the shape of a balloon, a fluid level and a thickened contrast-enhancing wall. Intraoperatively, a purple-blue tumor with fibrous adhesions was located between the right S1 and S2 nerve roots. Macroscopically, no signs of epidural bleedings could be denoted. After coagulation of a reticular venous feeder network and dissection of the adhesions the rubber ball-like lesion was resected in total. Histology revealed a prominent venous vessel with a pathologically thickened, amuscular wall surrounded by smaller, hyalinized, venous vessels arranged in a back-to-back position typical for the diagnosis of a cavernous angioma. Lumina were partially occluded by thrombi. The surrounding fibrotic tissue showed signs of recurrent bleedings. There was no obvious mass hemorrhage into the surrounding tissue. In this unique case, the pathologic mechanism was not the usual rupture of the cavernous angioma with subsequent intraspinal hemorrhage, but acute mass effect by intralesional bleedings and thrombosis with subsequent increase of volume leading to nerve root compression. Thus, even without a sudden intraspinal hemorrhage a spinal cavernous malformation can cause acute symptoms identical to the clinical features of a soft disc herniation.

Solitary spinal epidural cavernous angiomas in children presenting with acute neurological symptoms caused by hemorrhage

Spinal solitary epidural cavernous angiomas are rare benign vascular malformations, which occur even less frequently in children than in adults. It is uncommon to find such lesions without adjacent vertebral involvement. Occasionally, these lesions can lead to neurological symptoms through growth or due to intralesional hemorrhage. In this report the authors describe 2 children presenting with acute symptoms and neurological deficits caused by hemorrhage within solitary spinal epidural cavernous angiomas. A 13-year-old girl and a 9-year-old girl, previously healthy, were admitted to the authors' department due to acute radicular pain and neurological deficits. In both cases MR imaging revealed a solitary epidural mass with signs of bleeding and compression of the spinal cord. Complete resection of the lesion via a dorsal approach was performed in both patients. The histological examination of the lesions revealed the characteristic structures of a cavernous angioma with hemosiderin deposits and acute hemorrhage. Both patients recovered fully after surgical removal of the lesions. Review of the literature confirmed that spinal epidural cavernous angiomas are extremely rare in the pediatric patient population, described currently in only 2 instances, but without acute hemorrhage. These cases suggest that epidural cavernous angiomas also have to be considered in the pediatric patient population in the differential diagnosis of intraspinal lesions with acute or progressive neurological symptoms. Microsurgical resection of these cavernous malformations is an effective and curative treatment option.