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Joshi GK, Krishna KN, Krishna DG, Murthy GK, Herur A, Karnam SV. Dorsal Spinal Epidural Cavernous Angioma; A Case Report. Asian J Neurosurg 2021; 16:144-149. [PMID: 34211883 PMCID: PMC8202371 DOI: 10.4103/ajns.ajns_150_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/23/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal cavernous angiomas are lesions formed by vessels lined by closely clustered endothelial cells. They are common in the vertebral body and less common in an intradural location. However, these are very rare in the extra-osseous and epidural region. Less than 100 cases have been reported. Here, we report a case of dorsal spinal extradural cavernous angioma in a 52-year-old man who presented with back pain and difficulty in walking. Magnetic resonance imaging brain showed D7-D8 (thoracic) extradural spinal lesion, enhancing homogeneously on contrast administration. He underwent D7-D8 hemilaminectomy and tumor decompression. The tumor was extradural, tightly adherent to the dura, and highly vascular. He recovered completely after surgical removal with no recurrence 2 years after removal. He was not administered adjuvant radiotherapy. In this article, we review the literature regarding clinical features, imaging findings, and outcome of spinal epidural cavernous angioma.
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Affiliation(s)
- Girish Krishna Joshi
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - K N Krishna
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Dilip Gopal Krishna
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Ganesh K Murthy
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Ajay Herur
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
| | - Sundeep V Karnam
- Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
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Cervical Nerve Root Compression Due to Vertebral Artery Loop Indentation: Case Report. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:307-309. [PMID: 32774096 PMCID: PMC7406555 DOI: 10.5350/semb.20170517045234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 11/08/2022]
Abstract
Symptoms such as pain, numbness, and loss of muscle strength may occur as a result of cervical discopathies and spondylosis-associated cervical nerve palsy symptoms. Vertebral artery loop formation is a rare vascular pathology associated with nerve root compression resulting in similar clinical symptoms. The treatment strategy may be completely different following the diagnosis. Magnetic resonance imaging of the patient who admitted to our hospital due to complaints of right-sided numbness detected vertebral artery loop causing narrowing of the neural foraminal area and C3 nerve compression. No significant pathology was found in the Doppler ultrasound (US) examination performed for the vertebral artery vasculature following the examination. Cervical disc pathologies are the main pathology in the vast majority of patients suffering from cervical region pain and numbness and loss of strength. In rare cases, keeping in mind the other pathologies that constrain neural foraminal area is useful for differential diagnosis.
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Ben Nsir A, Hadhri R, Kilani M, Chabaane M, Darmoul M, Hattab N. Epidural Venous Angioma Presenting with Spinal Cord Compression in a 42-Year-Old Woman with Previous History of Ovarian Malignancy. World Neurosurg 2016; 93:488.e5-7. [PMID: 27368507 DOI: 10.1016/j.wneu.2016.06.090] [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: 05/19/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Venous angioma is an extremely rare vascular malformation of the epidural space. To the best of our knowledge, only 5 cases have been documented to date and none has been reported in the setting of a previous malignancy. CASE DESCRIPTION We report the case of a 42-year-old woman with a previous history of ovarian cancer, treated by surgery plus chemotherapy; who presented with signs of spinal cord compression for 3 weeks. Magnetic resonance imaging showed an intensely enhancing epidural mass at the T2-T6 level causing major spinal cord compression, for which urgent surgery was indicated. During surgery, the tumor was extremely hemorrhagic and the hemostasis was hazardous. Blood loss was estimated at 1.5 L, causing hemodynamic instability and requiring intensive resuscitation with fluids and blood transfusions. Gross total resection was achieved and the pathologic examination confirmed the diagnosis of venous angioma. The patient recovered quickly postoperatively and was able to walk independently within 2 weeks of starting intensive rehabilitation. She was symptom free with no clinical or radiologic evidence of recurrence at 1 year follow-up. CONCLUSIONS Venous angioma should be included in the differential diagnosis of spinal epidural masses even in case of previous malignancy. Subtle imaging features should alert clinicians to this rare yet potentially life-threatening condition. Surgery remains the cornerstone of the treatment and can result in remarkable recovery.
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Affiliation(s)
- Atef Ben Nsir
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, The University of Medicine of Monastir, Monastir, Tunisia.
| | - Rym Hadhri
- Department of Pathology, Fattouma Bourguiba University Hospital, The University of Medicine of Monastir, Monastir, Tunisia
| | - Mohamed Kilani
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, The University of Medicine of Monastir, Monastir, Tunisia
| | - Mohamed Chabaane
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, The University of Medicine of Monastir, Monastir, Tunisia
| | - Mehdi Darmoul
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, The University of Medicine of Monastir, Monastir, Tunisia
| | - Nejib Hattab
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, The University of Medicine of Monastir, Monastir, Tunisia
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Gandhoke GS, Yilmaz S, Grunwaldt L, Hamilton RL, Salvetti DJ, Greene S. A case of spinal epidural venous malformation with mediastinal extension: management with combined surgery and percutaneous sclerotherapy. J Neurosurg Pediatr 2016; 17:612-7. [PMID: 26771680 DOI: 10.3171/2015.9.peds15341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While spinal epidural arteriovenous malformations, fistulas, and shunts are well reported, the presence of a venous malformation in the spinal epidural space is a rare phenomenon. Herein, the authors report the clinical presentation, imaging findings, pathological features, and the outcome of surgical and percutaneous interventional management of a mediastinal and spinal epidural venous malformation in a young woman who presented clinically with neurogenic claudication from presumed venous hypertension precipitating the formation of a syrinx. The patient underwent a C6-T5 osteoplastic laminectomy for decompression of the spinal canal and subtotal resection of the epidural venous malformation, followed by percutaneous sclerotherapy of the mediastinal and residual anterior spinal venous malformation. She developed transient loss of dorsal column sensation, which returned to baseline within 3 weeks of the surgery. A 6-month postoperative MRI study revealed complete resolution of the syrinx and the mediastinal venous malformation. Twelve months after the surgery, the patient has had resolution of all neurological symptoms with the exception of her premorbid migraine headaches. A multidisciplinary approach with partial resection and the use of percutaneous sclerotherapy for the residual malformation can be used to successfully treat a complex venous malformation.
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Affiliation(s)
| | - Sabri Yilmaz
- Interventional Radiology.,Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania
| | - Lorelei Grunwaldt
- Plastic and Reconstructive Surgery, and.,Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania
| | | | | | - Stephanie Greene
- Departments of 1 Neurological Surgery.,Vascular Anomalies Center, Children's Hospital of Pittsburgh, Pennsylvania
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Wu L, Yang T, Deng X, Yang C, Xu Y. Spinal epidural venous angioma: a case report and review of the literature. Childs Nerv Syst 2014; 30:1601-5. [PMID: 24639010 DOI: 10.1007/s00381-014-2397-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND As a vascular malformation, venous angioma in the spinal cord is extremely rare. To our knowledge, there are only five case reports in the literature, and it has not been previously reported in the pediatric age group. CASE REPORT In this paper, we report on a 3-year-old patient who presented with progressive weakness in his left upper limb. Spinal magnetic resonance imaging (MRI) revealed an epidural cystic mass at the C6-T2 level. The lesion was diagnosed as venous angioma after total removal with laminectomy. Postoperatively, the patient remained symptom free, and no tumor recurrence was confirmed based on MRI at the time of the 18-month follow-up. The clinical, radiological, surgical, and pathological features of this abnormality are discussed, and all six reported cases were reviewed. CONCLUSION Venous angiomas should be included in the differential diagnosis of spinal cystic lesions in children. A definitive diagnosis is difficult based on MRI alone. This rare lesion is amenable to surgery, and gross total removal (GTR) is usually achievable due to a well-demarcated dissection plane. A good clinical outcome after GTR can be expected.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, 100050, Beijing, China
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6
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Nishimura Y, Hara M, Natsume A, Nakajima Y, Fukuyama R, Wakabayashi T, Ginsberg HJ. Spinal intradural cystic venous angioma originating from a nerve root in the cauda equina. J Neurosurg Spine 2013; 19:716-20. [DOI: 10.3171/2013.8.spine121012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A spinal intradural extramedullary venous angioma is extremely rare and has not been previously reported. In this paper, the authors report on this entity with morphological and immunohistochemical evidence, and discuss the surgical strategy for its treatment. A 54-year-old woman presented to Nagoya University Hospital complaining of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the previous 2 weeks. Lumbar spine MRI showed an intradural extramedullary cyst at the level of T12–L1, which extended from the conus medullaris to the cauda equina. The cyst wall was not enhanced on T1-weighted MRI with Gd. Intraoperatively, a midline dural opening allowed the authors to easily visualize a dark-reddish cyst behind the spinal nerve rootlets in the cauda equina adjacent to the conus medullaris. The cyst was believed to originate from one of the spinal nerve rootlets in the cauda equina and a cluster of veins was identified on the cyst wall. The cyst was resected with the affected nerve rootlet. The surgery left no detectable neurological deficit. Based on the morphological and immunohistochemical evidence, the lesion was diagnosed as a venous angioma. No tumor recurrence was confirmed based on MRI at the time of the 2-year follow up. This is the first report of an intradural extramedullary cystic venous angioma that was successfully resected.
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Affiliation(s)
- Yusuke Nishimura
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Masahito Hara
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Atsushi Natsume
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | | | | | | | - Howard J. Ginsberg
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Sharma MS, Borkar SA, Kumar A, Sharma MC, Sharma BS, Mahapatra AK. Thoracic extraosseous, epidural, cavernous hemangioma: Case report and review of literature. J Neurosci Rural Pract 2013; 4:309-12. [PMID: 24250167 PMCID: PMC3821420 DOI: 10.4103/0976-3147.118772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 40-year-old male presented with mid-thoracic backache and progressive, ascending, spastic, paraparesis for one year. Magnetic resonance imaging demonstrated an extraosseous, extradural mass, without any bone invasion at the T2-T4 vertebral levels, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was totally excised after a T2-T4 laminectomy. Histopathological examination revealed a cavernous hemangioma. The authors reported this case and reviewed the literature, to explain why extraosseous, extradural, cavernous hemangiomas should be considered in the differential diagnosis of extradural thoracic compressive myelopathy.
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Affiliation(s)
- Manish S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi - 110 029, India
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8
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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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9
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An unusual cause of lumbar radiculopathy. J Clin Neurosci 2013. [DOI: 10.1016/j.jocn.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Chibbaro S, Mirone G, Yasuda M, Marsella M, Di Emidio P, George B. Vertebral artery loop--a cause of cervical radiculopathy. World Neurosurg 2011; 78:375.e11-3. [PMID: 22381311 DOI: 10.1016/j.wneu.2011.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 10/24/2011] [Accepted: 12/01/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a case of cervical radiculopathy caused by an anomalous vertebral artery (VA) and illustrate the efficacy of microvascular decompression by the anterolateral approach. METHODS A 50-year-old woman was referred because of an 8-year history of progressive left C6 radiculopathy refractory to other forms of treatment, including C5-6 anterior cervical discectomy. Clinical and radiologic evaluation showed an abnormally tortuous loop of V2 causing direct neurovascular compression. RESULTS A left cervical anterolateral approach was used to expose the anomalous loop. After a generous bony decompression, the loop was identified, and the artery was mobilized and ultimately separated from the C6 nerve root removing the direct pulsatile compression. CONCLUSIONS Cervical root compression by an aberrant or anomalous extracranial VA is a rare cause of radiculopathy. The best management of such lesions is the anterolateral approach with bony and direct microvascular decompression.
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Affiliation(s)
- Salvatore Chibbaro
- Department of Neurosurgery, Laribosiere University Hospital, Paris, France.
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Santoro A, Piccirilli M, Bristot R, di Norcia V, Salvati M, Delfini R. Extradural spinal cavernous angiomas: report of seven cases. Neurosurg Rev 2005; 28:313-9. [PMID: 15926084 DOI: 10.1007/s10143-005-0390-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Accepted: 02/19/2005] [Indexed: 10/25/2022]
Abstract
The authors describe seven cases of extradural spinal cavernous angioma. Although cavernoma itself is not rare, the extradural spinal localization is uncommon and makes preoperative differential diagnosis difficult. Routine MRI investigation has aided neurosurgeons in evaluating the true incidence of these vascular malformations, which was understimated in the past. The data published so far have not entirely clarified the treatment of choice for these lesions. Considering their rarity in this site, their presenting symptoms and the difficulties involved in neuroradiological diagnosis, the authors discuss the role of surgery as the principal form of treatment and review the relevant literature. Seven patients (4 male, 3 female) were admitted to our Institute of Neurosurgery between 1992 and 2004, with a 5-6 month history (range=2-365 days) of low back pain or radicular pain, sometimes associated with paresthesia. All patients had a CT scan, as well as MRI with gadolinium when possible, which detected an extradural roundish lesion: differential diagnosis was very difficult, especially between neurinoma and cavernoma. Treatment was always surgical and resection of the lesion radical. Postoperatively, all patients presented complete regression of clinical symptoms. In all cases histological diagnosis was cavernous angioma. Postoperative MRI with gadolinium or CT scan with IV contrast, performed before discharge, confirmed radical removal of the vascular malformation in all cases. Our experience confirms that surgery should be the treatment of choice for these lesions, in view of both their tendency to bleed and their straightforward surgical removal.
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Affiliation(s)
- Antonio Santoro
- Department of Neurosurgical Sciences, Neurosurgery, University of Rome, La Sapienza, Rome, Italy.
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12
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D'Andrea G, Ramundo OE, Trillò G, Roperto R, Isidori A, Ferrante L. Dorsal foramenal extraosseous epidural cavernous hemangioma. Neurosurg Rev 2003; 26:292-6. [PMID: 14520522 DOI: 10.1007/s10143-003-0275-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2003] [Accepted: 03/21/2003] [Indexed: 10/25/2022]
Abstract
Cavernous hemangiomas are vascular hamartomatous malformations that affect the central nervous system. This pathology is frequently encountered in the cerebral hemispheres, cerebellum, and brainstem. Cavernous hemangiomas infrequently occur at the spinal level or relative to an intramedullary localization; extramedullary epidural sites are also sometimes affected by this pathology. We report an extradural, extramedullary, cavernous hemangioma with foramenal extension of the dorsal section and discuss the differential diagnosis with dorsal foramenal neurinoma. A 52-year-old woman was admitted with irritation and deficit symptoms radiating into the left D3 spinal root space. The first radiological diagnosis was of a foramenal neurinoma beginning at the D3 root. The presence of a heterogeneous MR signal in both T1 and T2 images led us to consider the differential diagnosis of a cavernous hemangioma lesion. The patient underwent microsurgical treatment with a far lateral extraforamenal approach. Symptoms quickly improved: pain and dysesthesia disappeared after surgery and only light hypoesthesia was found. We want to stress the importance of MR imaging in formulating a correct differential diagnosis with foramenal neurinoma and underline that microsurgical treatment with a far lateral extraforamenal approach allowed us to remove the lesion completely without affecting Denis's posterior column, the lamina, and the articular facet.
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13
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Goyal A, Singh AK, Gupta V, Tatke M. Spinal epidural cavernous haemangioma: a case report and review of literature. Spinal Cord 2002; 40:200-2. [PMID: 11965560 DOI: 10.1038/sj.sc.3101248] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A case report of purely epidural cavernous haemangioma with MRI appearance and pathological features. OBJECTIVE To present a rare case of extradural mass with differential diagnosis. SETTING Delhi, India. METHOD A 55-year-old man presented with progressive weakness and diminished sensation in both lower limbs. MRI demonstrated a pure extradural mass with no bony invasion. Histopathology of the lesion revealed a typical cavernous haemangioma. RESULT The patient showed significant improvement after surgery. CONCLUSION Radiological presentation could be confusing in a purely epidural cavernous haemangioma. Awareness of the characteristics of the lesion will facilitate diagnosis and treatment of the lesion.
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Affiliation(s)
- A Goyal
- Department of Neurosurgery, G.B. Pant Hospital, Delhi, India
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14
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Appiah GA, Knuckey NW, Robbins PD. Extradural spinal cavernous haemangioma: case report and review of the literature. J Clin Neurosci 2001; 8:176-9. [PMID: 11243772 DOI: 10.1054/jocn.2000.0756] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cavernous haemangiomas (cavernomas) are uncommon vascular malformations of the central nervous system (CNS). They occur in both sporadic and familial forms and may involve any site in the CNS. Spinal cavernomas are less common than intracerebral lesion s, and examples in the spinal epidural space are rare. A case of a solitary sporadic spinal extradural cavernoma in a 41 year old male which presented as progressive lower limb numbness and weakness is reported. The literature regarding spinal cavernomas is reviewed and the symptomatology, diagnostic evaluation, pathology, management and prognosis of these lesions are discussed.
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Affiliation(s)
- G A Appiah
- Neurosurgical Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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Shin JH, Lee HK, Rhim SC, Park SH, Choi CG, Suh DC. Spinal epidural cavernous hemangioma: MR findings. J Comput Assist Tomogr 2001; 25:257-61. [PMID: 11242225 DOI: 10.1097/00004728-200103000-00019] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cavernous hemangiomas with a spinal epidural location are very uncommon vascular tumors in contrast to those in the vertebral body. The purpose of this study was to describe the radiologic findings, focusing on the MR studies, of spinal epidural cavernous hemangiomas. METHOD Five pathologically proven cases of spinal epidural cavernous hemangioma were retrospectively reviewed. MR (n = 5) and CT (n = 1) were evaluated. RESULTS The level was thoracic (n = 4) or lumbosacral (n = 1). The mass was located in the epidural space and showed paravertebral extension in all cases. It showed a lobulated contour in all cases and encircled the spinal cord partially with a larger posterior (n = 3) or anterior (n = 1) component in four cases. In all cases, the mass showed high signal intensity on T2-weighted images and homogeneous, strong enhancement. Adjacent bony erosion (n = 5) and intervertebral neural foraminal widening (n = 4) were common. CONCLUSION Spinal epidural cavernous hemangioma shows characteristic MR findings of a lobulated contoured epidural mass partially encircling the spinal cord with a larger posterior component in the spinal canal, high signal intensity on T2-weighted images, and homogeneous, strong enhancement.
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Affiliation(s)
- J H Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Detwiler PW, Porter RW, Harrington TR, Sonntag VK, Spetzler RF. Vascular decompression of a vertebral artery loop producing cervical radiculopathy. Case report. J Neurosurg 1998; 89:485-8. [PMID: 9724128 DOI: 10.3171/jns.1998.89.3.0485] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The authors present the case of a 70-year-old man with 9 years of progressive right-sided cervical and scapular pain but no history of trauma. Computerized tomography myelography and magnetic resonance imaging revealed an ovoid mass in the right C3-4 intervertebral foramen. The patient underwent a right C-3 and C-4 hemilaminectomy and a complete C3-4 facetectomy. A pulsatile vascular structure was found compressing the right C-4 nerve root. The bone overlying the vascular structure was removed, producing decompression of the nerve root. Immediate postoperative angiography showed that this lesion was a focal vertebral artery loop. The patient's symptoms resolved after surgery, supporting the use of vascular decompression of a cervical nerve root compressed by a vertebral artery loop for the relief of radicular symptoms.
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Affiliation(s)
- P W Detwiler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA
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17
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Zevgaridis D, Büttner A, Weis S, Hamburger C, Reulen HJ. Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature. J Neurosurg 1998; 88:903-8. [PMID: 9576262 DOI: 10.3171/jns.1998.88.5.0903] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epidural cavernous hemangiomas are increasingly identified as a cause of acute or chronic progressive spinal cord syndrome and local back pain or radiculopathy. The authors present three cases of spinal epidural cavernous hemangiomas manifesting as spinal cord syndrome, thoracic radiculopathy, and lumbar radiculopathy. Based on the imaging characteristics of these three cases and a review of the literature, the clinical signs and symptoms and their implications, the role of preoperative neuroradiological diagnosis, and the need for complete surgical resection are discussed. Epidural cavernous hemangiomas display consistent magnetic resonance imaging properties: T1-weighted images most commonly show a homogeneous signal intensity similar to those of spinal cord and muscle, and contrast enhancement is homogeneous or slightly heterogeneous. On T2-weighted images the signal of the lesion is consistently high and slightly less intense than that of cerebrospinal fluid. Frequently, the lesion is characterized by its extension through the intervertebral foramen. Awareness of these characteristics facilitates diagnosis and treatment of the lesions. Despite the risk of bleeding, in all three cases complete surgical excision was achieved.
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Affiliation(s)
- D Zevgaridis
- Department of Neurosurgery and Institute of Neuropathology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany
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18
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Spinal Epidural Cavernous Angioma Presenting As a Lumbar Radiculopathy with Analysis of Magnetic Resonance Imaging Characteristics. Neurosurgery 1995. [DOI: 10.1097/00006123-199503000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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19
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Harrington JF, Khan A, Grunnet M. Spinal epidural cavernous angioma presenting as a lumbar radiculopathy with analysis of magnetic resonance imaging characteristics: case report. Neurosurgery 1995; 36:581-4. [PMID: 7753358 DOI: 10.1227/00006123-199503000-00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Epidural cavernous angiomas are apparently rare lesions. We present an unusual case of chronic lumbar radiculopathy secondary to an epidural cavernous hemangioma extending into the intervertebral foramen. Few such reports have had the benefit of modern neuroimaging techniques to aid in preoperative diagnosis, and, therefore, magnetic resonance imaging of these lesions has not been extensively described. This article discusses the implications of the clinical presentation of the patient and reviews the characteristic magnetic resonance imaging appearance of this lesion garnered from this case and from a review of the literature.
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Affiliation(s)
- J F Harrington
- University of Connecticut Health Center, Surgical Research Center, Farmington, USA
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21
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Graziani N, Bouillot P, Figarella-Branger D, Dufour H, Peragut JC, Grisoli F. Cavernous angiomas and arteriovenous malformations of the spinal epidural space: report of 11 cases. Neurosurgery 1994; 35:856-63; discussion 863-4. [PMID: 7838334 DOI: 10.1227/00006123-199411000-00009] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We have retrospectively studied 11 cases of solitary cavernous and arteriovenous malformations of the spinal epidural space. The acute or subacute onset of symptoms was found in all cases, with a neurological deficit in five cases. A plain x-ray study revealed abnormal calcification in one case. Hyperdensity with no iodine enhancement was found on computed tomographic scans in all cases. Magnetic resonance imaging studies showed ovoid or round lesions with isosignal and gadolinium enhancement on T1-weighted images and hypersignal on T2-weighted images, except in one case with hypersignal on T1 and T2 before the administration of a contrast medium. Four lumbar cases were localized in the posterior vertebral ligament; all the thoracic cases were posterior with foraminal extension. The other cases were anterolateral. The surgical findings revealed a dark vascularized epidural lesion associated in two cases with a localized epidural hematoma. A pathological examination revealed seven cavernous angiomas and four arteriovenous malformations. These arteriovenous malformations were all lumbar, and two of four localized within the posterior ligament. The pathophysiology of these vascular malformations is discussed. In light of the good postoperative prognosis of these lesions, surgical removal is recommended for all the symptomatic cases.
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Affiliation(s)
- N Graziani
- Department of Neurosurgery, CHU La Timone, Marseille, France
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Hillman J, Bynke O. Solitary extradural cavernous hemangiomas in the spinal canal. Report of five cases. SURGICAL NEUROLOGY 1991; 36:19-24. [PMID: 2053068 DOI: 10.1016/0090-3019(91)90127-u] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Five cases of solitary extrathecal cavernous hemangioma in the spinal canal are reported. In one case, two coexistent massive cerebral venous medullary malformations were found. The symptomatology and prognosis of extrathecal spinal cavernous hemangiomas are discussed, as is the significance of various diagnostic measures. The patient material further permitted a rough calculation of the incidence of symptomatic extrathecal cavernous hemangiomas in the spinal canal.
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Affiliation(s)
- J Hillman
- Department of Neurology, University Hospital, Linköping, Sweden
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Abstract
Three cases of isolated spinal extradural cavernous hemangiomas are reported, two in the thoracic and one in the lumbar region. One of them manifested as acute cord compression, the other two as chronic progressive myelopathy or radiculopathy. A total excision or subtotal excision with irradiation was performed. All of them had good functional recovery. The clinical picture, radiological diagnosis, and optimal method of treatment are discussed. The relevant literature is reviewed.
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Affiliation(s)
- J P Lee
- Department of Radiology, Chang Gung Medical College & Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Morioka T, Nakagaki H, Matsushima T, Hasuo K. Dumbbell-shaped spinal epidural cavernous angioma. SURGICAL NEUROLOGY 1986; 25:142-4. [PMID: 3941982 DOI: 10.1016/0090-3019(86)90282-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case of a spinal epidural cavernous angioma extending in the intra- and extravertebral spaces through the intervertebral foramen is presented. It was dumbbell shaped, but did not show enlargement of the intervertebral foramen, a common sign that is thought to be helpful in the diagnosis of spinal neurinoma.
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