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Biancardino AA, Marrone S, Paolini F, Giovannini EA, Cinquemani G, Lipani R, Ruggeri L, Mandelli J, Crea A, Vaccaro G, Iacopino DG, Basile L. Coexistence of mastoid, frontal and vertebral hemangiomas in a patient with diabetic neuropathy: Possible correlation between diabetic angiopathy and intraosseous neoangiogenesis. Radiol Case Rep 2024; 19:2937-2942. [PMID: 38737173 PMCID: PMC11087693 DOI: 10.1016/j.radcr.2024.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/16/2024] [Accepted: 03/29/2024] [Indexed: 05/14/2024] Open
Abstract
Bony hemangiomas are benign vascular lesions with an expansive growth; usually they tend to obliterate the entire bony cavity. They are typical lesion of the spinal bones, but they can rarely arise within other bones of the neurocranium. Diabetic microangiopathy is a condition characterized by the development of aberrant vessel tangles anastomosed to each other due to dysregulated neoangiogenesis. We report the case of a 56-year-old woman, suffering from type 2 diabetes mellitus, admitted to the neurology department due to a reported worsening of paresthesias and dysesthesias of the upper and lower limbs. She performed a contrast-enhanced brain CT scan that showed the presence, at the level of the right mastoid process, of an hypervascular angioma. A subsequent MRI study of the brain and spine showed the presence of multiple bone angiomas, at the level of the right frontal theca and C7, Th3, and Th7 vertebral bodies. Due to the absence of further symptoms and clinical and radiological signs of intracranial compression, the patient did not perform surgery. A radiological follow-up was advised. Although possible pathophysiological correlations between diabetes and vertebral hemangiomas are mentioned in literature, vascular lesions of this type involving vertebrae and skull base simultaneously can be discovered in a patient with chronic diabetic disease. As long as these lesions remain asymptomatic, surgical treatment is not indicated, and the patient is followed over time with radiological follow-up.
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Affiliation(s)
- Antonio Alessandro Biancardino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | | | - Federica Paolini
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
| | - Evier Andrea Giovannini
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
| | | | - Rita Lipani
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
| | - Luca Ruggeri
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
| | - Jaime Mandelli
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
| | - Antonio Crea
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
| | - Giuseppe Vaccaro
- Unit of Diagnostic Imaging, S. Elia Hospital, 93100 Caltanissetta, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Luigi Basile
- Unit of Neurosurgery, S. Elia Hospital, 93100 Caltanissetta, Italy
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Ribeiro L, Dunoyer C, Trinquet A, Cagnazzo F, Boetto J, Le Corre M. Adult transverse sinus capillary hemangioma: case report and review of the literature. Neurochirurgie 2024; 70:101573. [PMID: 38851138 DOI: 10.1016/j.neuchi.2024.101573] [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: 03/25/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Adult intracranial capillary hemangioma (ICH) is an extremely rare disease with very few cases reported in the literature. Natural history is poorly understood and therapeutic management has not been clearly defined. METHODS Using PRISMA guidelines, we systematically reviewed all published adult cases of ICH, to which we added our own case. CASE PRESENTATION A 24-year-old patient with intracranial hypertension underwent stenting for left transverse sinus ICH. Recurrence was managed by subtotal resection, and radiotherapy was undertaken after a second relapse. Radiotherapy achieved complete response at last follow-up. RESULTS Among cases of ICH found in the literature, 36 concerned adults (55.3%), with clear female predominance, and only 2 cases affecting the transverse sinus (8.1%). Adult ICHs grew over time, and pregnancy seemed to accelerate natural progression. Complete resection was achieved in most cases, and radiotherapy was used in case of relapse, with high rates of tumor control. CONCLUSION Transverse sinus ICH is uncommon, and venous stenting is a suitable option in case of tumor invasion to treat intracranial hypertension. Surgery is the gold-standard treatment, and radiotherapy is a very effective alternative, with high rates of tumor control. Natural history is not benign, particularly in case of pregnancy.
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Affiliation(s)
- Lucas Ribeiro
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
| | - Clément Dunoyer
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Aude Trinquet
- Department of Neuropathology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Julien Boetto
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; Institute of Functional Genomics (IGF), Université de Montpellier, CNRS, INSERM, U1191, Montpellier, France
| | - Marine Le Corre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Deng J, Zhang D, Yang J, Peng D, Chen Y. Increased 68 Ga-FAPI Uptake in Capillary Hemangiomas in an Adult Patient. Clin Nucl Med 2024; 49:572-573. [PMID: 38466027 DOI: 10.1097/rlu.0000000000005144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT A 67-year-old woman was enrolled in our 68 Ga-FAPI PET/CT tumor clinical trial due to her lung adenocarcinoma. The PET/CT scan additionally revealed increased uptake of FAPI in the tongue. Combined with the patient's medical history and the contrast-enhanced CT of the maxillofacial region, it was suspected to be a hemangioma. Subsequently, the patient underwent surgery and was diagnosed with capillary hemangioma of the left side of her tongue.
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Affiliation(s)
| | - Dongmei Zhang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Yamamoto Y, Shimauchi-Ohtaki H, Honda F, Shirakura T, Aramaki K, Shintoku R, Miyagishima T, Aihara M, Yokoo H, Yoshimoto Y. Thoracic Intra and Extramedullary Capillary Hemangioma with Subacute Clinical Course: A Case Report and Literature Review. NMC Case Rep J 2024; 11:85-91. [PMID: 38666032 PMCID: PMC11043801 DOI: 10.2176/jns-nmc.2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 04/28/2024] Open
Abstract
Capillary hemangiomas are benign tumors comprising a lobulated proliferation of capillary vessels frequently located in the soft tissues of the neck and head. Spinal intradural capillary hemangiomas are rare, particularly intramedullary lesions. To our knowledge, only 31 cases of spinal intramedullary capillary hemangiomas have been reported. Here, we describe a rare case of a thoracic capillary hemangioma comprising extramedullary and intramedullary components. A 51-year-old male patient presented with bilateral lower extremity numbness and subsequent paraparesis, sensory disturbance, and bladder-bowel dysfunction with a subacute clinical course. Magnetic resonance imaging revealed a mass lesion with intramedullary and intradural extramedullary components at the Th9-10 vertebrae level and widespread spinal cord edema. Contrast-enhanced computed tomography revealed abnormal vessels on the dorsal spinal cord surface. Spinal angiography revealed a light-stained mass lesion fed by the radiculopial artery from the right Th11 intercostal artery. The tumor was resected en bloc, and the histological diagnosis was a capillary hemangioma. Postoperatively, the spinal cord edema diminished, and the patient was discharged from the convalescent rehabilitation ward. Although intramedullary capillary hemangioma is a rare spinal tumor and its preoperative diagnosis is difficult, it should be considered in the differential diagnosis of spinal intramedullary tumors.
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Affiliation(s)
- Yumeki Yamamoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroya Shimauchi-Ohtaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Fumiaki Honda
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takahiro Shirakura
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Keigo Aramaki
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ryosuke Shintoku
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masanori Aihara
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Lee JS, Lee JY, Park SH, Wang KC, Kim KH. Intramedullary spinal capillary hemangioma with secondary neurulation defect in children. Childs Nerv Syst 2024; 40:1287-1294. [PMID: 38240785 PMCID: PMC10972978 DOI: 10.1007/s00381-024-06276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/03/2024] [Indexed: 03/28/2024]
Abstract
Intramedullary spinal capillary hemangioma is a rare occurrence in pediatric patients, and only limited cases have been reported. This study presents the first two cases of spinal capillary hemangioma co-present with retained medullary cord and one case of spinal capillary hemangioma with lumbosacral lipomatous malformation. Previous literature on ten patients with this pathology was reviewed. We speculated pathogenesis, imaging features, and histopathologic findings of the disease.
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Affiliation(s)
- Jong Seok Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Neural Development and Anomaly Laboratory, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Neuro-Oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang, Republic of Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Sun J, Li J, Ayi Z, Yang F, Hu J, Hui X, Chen H, He J. Case report: A cystic capillary hemangioma located at the conus medullaris mimicking hemangioblastoma. Front Neurol 2024; 15:1350780. [PMID: 38606279 PMCID: PMC11006963 DOI: 10.3389/fneur.2024.1350780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Capillary hemangiomas, usually found in skin and mucosal tissues, are rarely encountered within the spinal cord, presenting a significant diagnostic challenge. We report a rare case of intradural extramedullary capillary hemangioma at the conus medullaris in a 66-year-old female patient. Our initial diagnosis leaned towards a cystic hemangioblastoma based on MRI findings due to the presence of cystic formation with an enhanced mural nodule. However, surgical exploration and subsequent pathological examination revealed the lesion as a capillary hemangioma. To the authors' knowledge, this case may represent the first documented instance of a spinal capillary hemangioma that mimics a cystic hemangioblastoma.
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Affiliation(s)
- Jiachen Sun
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiuhong Li
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ziba Ayi
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Feilong Yang
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Junlin Hu
- Department of Neurosurgery, People’s Hospital of Renshou, Meishan, China
| | - Xuhui Hui
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Haifeng Chen
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiaojiang He
- Department of Neurosurgery/Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
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MacLellan AD, Easton AS, Alubankudi R, Pickett GE. Documented growth of an intracranial capillary hemangioma: A case report. Neuropathology 2024; 44:76-82. [PMID: 37403213 DOI: 10.1111/neup.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
Intracranial capillary hemangiomas in adults are rare, and diagnosis can be challenging. Hemangiomas, in general (and particularly in the skin), are more often noted in the pediatric population. Due to the lack of imaging undertaken in the presymptomatic phase, the literature provides few clues on the rate of growth of these unusual tumors. Therefore, we report a case of a 64-year-old man with a medical history of Lyme disease who presented with exhaustion and confusion. Imaging demonstrated an intra-axial lesion with vascularity in the posterior right temporal lobe, raising the possibility of a glioma. Imaging two years prior revealed a very small lesion in the same location. The patient underwent a craniectomy, total resection of the lesion was completed, and his symptoms of confusion resolved. Biopsy revealed a capillary hemangioma composed of small vascular channels lined by endothelial cells and pericytes without smooth muscle. Features of glioma, vascular neoplasms or neuroborreliosis (cerebral Lyme disease) were not identified. Our case documents the growth over two years of a rare intracranial capillary hemangioma in an older adult male.
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Affiliation(s)
| | - Alexander S Easton
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rufus Alubankudi
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gwynedd E Pickett
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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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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Sasaki K, Kuge A, Shimokawa Y, Yamaki T, Kondo R, Sonoda Y. Intracranial parenchymal capillary hemangioma: A case report. Surg Neurol Int 2023; 14:401. [PMID: 38053706 PMCID: PMC10695465 DOI: 10.25259/sni_695_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Background Capillary hemangioma is a rare benign hemangioma that occurs in the soft tissues of the skin, orbit, head, and neck. Intracranial cases, especially intraparenchymal cases, are extremely rare. In this study, we report the course of an intracranial parenchymal capillary hemangioma with left mild motor paresis and involuntary movements of the left upper extremity and was successfully treated by surgical resection, including radiological and pathological examinations. Case Description This is a case of a 60-year-old woman who presented with motor weakness and involuntary movement of the left upper extremity. Computed tomography and magnetic resonance imaging revealed the right frontal hemorrhagic mass lesion without enhancement of contrast medium. Cerebral digital subtraction angiography showed no vascular stain and abnormal arteriovenous shunt. Preoperatively, we diagnosed cavernous hemangioma with a hemorrhagic component located in the right motor cortex. Because this case was symptomatic, we performed a craniotomy and gross total resection of the right frontal lesion. The diagnosis of capillary hemangioma was made by histological examination, including immunohistological study. Conclusion Because intraparenchymal capillary hemangiomas are difficult to diagnose with preoperative imaging, surgical treatment, and histopathological examination are important.
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Affiliation(s)
- Kosuke Sasaki
- Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Atsushi Kuge
- Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, Japan
- Department of Emergency Medicine, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yu Shimokawa
- Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Tetsu Yamaki
- Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Rei Kondo
- Department of Neurosurgery, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Yamagata University, Yamagata, Japan
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Sahin MC, Bozkurt OF, Sahin MM, Celtikci E. Cavernous Sinus capillary hemangioma: Case report and literature review. BRAIN & SPINE 2023; 3:101776. [PMID: 38021022 PMCID: PMC10668058 DOI: 10.1016/j.bas.2023.101776] [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: 12/26/2022] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 12/01/2023]
Abstract
Introduction Capillary hemangioma of the cavernous sinus is considered a benign vascular skull base tumor. In this case report, a patient with capillary hemangioma located in the cavernous sinus who was operated on with endoscopic endonasal approach is presented. Research question What should be considered when planning the treatment for capillary hemangiomas located in the cavernous sinus? Material and methods The treatment approaches applied in 12 patients with a diagnosis of capillary hemangioma located in the cavernous sinus, reported in the English literature, are reviewed in this article. We presented the clinical and radiological results of the treatments. Results Cavernous sinus capillary hemangiomas are considered benign tumors. However, surgical treatment is preferred in the foreground because of the neurological deficits due to the compression effect caused by the mass. In the case reported by Masman et al. for the first time in the literature in 2021, they provided total excision with the endoscopic endonasal approach in the patient they first diagnosed by taking a biopsy with the endoscopic endonasal approach. In our case report, we provided total excision with endoscopic endonasal transsphenoidal approach. Discussion and conclusion Many factors should be considered when deciding on the treatment method in these patients. Although radiotherapy is quite effective in the treatment of capillary hemangioma, surgery should be preferred, especially in symptomatic patients. In patients who cannot undergo surgery, radiotherapy is very valuable, although the long-term results are not yet known.
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Affiliation(s)
- Mustafa Caglar Sahin
- Gazi University Medical School Department of Neurosurgery, 06560, Ankara, Turkey
| | - Omer Faruk Bozkurt
- Gazi University Medical School Department of Neurosurgery, 06560, Ankara, Turkey
| | - Muammer Melih Sahin
- Gazi University Medical School Department of Otorhinolaryngolog y, 06560, Ankara, Turkey
| | - Emrah Celtikci
- Gazi University Medical School Department of Neurosurgery, 06560, Ankara, Turkey
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Protas M, Ojukwu DI, Draytsel DY, Galgano MA. Illustrative resection of mixed intra- and extramedullary thoracic spinal cord capillary hemangioma. Surg Neurol Int 2023; 14:226. [PMID: 37404490 PMCID: PMC10316201 DOI: 10.25259/sni_402_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Background Capillary hemangiomas are typically superficial benign tumors of the cutaneous and mucosal tissues of the face and neck in pediatric patients. In adults, they typically occur in middle-aged males who present with pain, myelopathy, radiculopathy, paresthesias, and bowel/bladder dysfunction. The optimal treatment for intramedullary spinal cord capillary hemangiomas is gross total/en bloc resection. Methods Here, we present a 63-year-old male with increasing right greater than left lower extremity numbness/ weakness, attributed to a T8-9 mixed intra- and extramedullary capillary hemangioma. Results One year following complete lesion resection, the patient used an assistive device to ambulate and continued to improve neurologically. Conclusion We presented a 63-year-old male whose paraparesis was attributed to a T8-9 mixed intra- and extramedullary capillary hemangioma who did well following total en bloc lesion resection. In addition to this case study/technical note, we provide a 2-D intraoperative video detailing the resection technique.
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Affiliation(s)
- Matthew Protas
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, United States
| | - Disep I. Ojukwu
- St. George’s University, School of Medicine, Great River, New York, United States
| | - Dan Y. Draytsel
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, United States
| | - Michael A. Galgano
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, United States
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, United States
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Wardhana DPW, Awyono S, Lauren C, Muhammad Rosyidi R, Saputra H. Intraparenchymal cerebellar capillary hemangioma in a 32-year-old man: a case report. Front Surg 2023; 10:1141522. [PMID: 37228758 PMCID: PMC10203496 DOI: 10.3389/fsurg.2023.1141522] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
The authors present an unusual case of a 32-year-old adult male with a capillary hemangioma, which developed within the left cerebellar parenchyma. The histopathological examination reveals a mass mostly formed by the proliferation of capillaries, lined by a layer of flat-plump endothelial cells, some branching and dilating large capillaries, forming a lobulated structure separated by fibrocollagenous connective tissue. Immunohistochemistry examination with CD31 and S100 was positive on the endothelial and stromal cells, respectively, and negative S100 on the endothelial cells. Although rare, capillary hemangioma should be one of the differential diagnoses for diagnosing intra-axial lesions in the cerebellar region. Confirmation of the histopathological characteristic is necessary to determine the diagnosis of capillary hemangioma and exclude other differential diagnoses.
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Affiliation(s)
- Dewa Putu Wisnu Wardhana
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Academic Hospital of Universitas Udayana, Universitas Udayana,Badung, Indonesia
| | - Steven Awyono
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana,Denpasar, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana,Denpasar, Indonesia
| | - Rohadi Muhammad Rosyidi
- Department of Neurosurgery, West Nusa Tenggara General Hospital, Medical Faculty of Mataram University,Mataram, Indonesia
| | - Herman Saputra
- Department of Anatomical Pathology, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana,Denpasar, Indonesia
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Srienc AI, Mahlokozera T, Connor MR, Han PC, Pennicooke BH. Resection of an Intradural Extramedullary Capillary Hemangioma in the Lumbar Spine. Oper Neurosurg (Hagerstown) 2022; 23:e132-e136. [PMID: 35838475 DOI: 10.1227/ons.0000000000000266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/06/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Capillary hemangiomas are space-occupying lesions that rarely affect the central nervous system. When they present within the spinal canal, they can cause insidious symptoms and threaten neurological function. In this study, we present a case of an intradural extramedullary capillary hemangioma of the lumbar spine, discuss our management strategy, and review the current literature. For the first time for this diagnosis, we also provide an operative video. CLINICAL PRESENTATION The patient is a previously healthy 40-year-old man who presented with complaints of progressive low back and leg pain, numbness, and intermittent subjective urinary incontinence. MRI revealed a discrete, homogenously enhancing intradural extramedullary lesion at L4. This lesion was resected by performing an L4 laminoplasty, which entails en bloc removal of the L4 lamina and then securing it back into place once the intradural resection and dural closure are completed. Histological analysis revealed a diagnosis of capillary hemangioma. The patient had full resolution of his symptoms postoperatively. DISCUSSION Definitive management of spinal capillary hemangiomas involves gross total resection and can be accomplished with laminoplasty. Because these benign tumors can be adherent to adjacent structures, intraoperative neuromonitoring is helpful adjunct to preserve neurological function for a good outcome. CONCLUSION Capillary hemangiomas rarely affect the spine but should be considered on the list of differential diagnoses of intradural lesions.
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Affiliation(s)
- Anja I Srienc
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Tatenda Mahlokozera
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA.,Medical Scientist Training Program, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michelle R Connor
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Peng Cheng Han
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Brenton H Pennicooke
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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14
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Zhao Z, Zheng J, Zhou Y. Intradural extramedullary capillary hemangioma with intramedullary component: A case series. Medicine (Baltimore) 2022; 101:e29862. [PMID: 35905223 PMCID: PMC9333478 DOI: 10.1097/md.0000000000029862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological characteristics, and pathological features of capillary hemangioma in the spinal cord and to share our experience for the diagnosis and treatment of intradural extramedullary capillary hemangioma. PATIENT CONCERNS Three patients underwent surgical treatment at our hospital between January 2020 and August 2020. All patients were male[median age at presentation: 57 years (range: 56-60)]. Two patients were experiencing pain and numbness in the lower back, and 1 patient was experiencing numbness and weakness in the left lower limb. The duration of symptoms ranged from 1 to 5 months. DIAGNOSIS All patients were diagnosed with spinal cord capillary hemangioma after treatment. All lesions were in an intradural extramedullary location and involved spinal cord components. Two patients had lesions in thoracic segments (T8, Th9-10), and 1 patient had a lesion in lumbar segment (L1). INTERVENTIONS All patients underwent microscopic laminectomy and complete resection of the extramedullary and intramedullary components of the spinal cord capillary hemangiomas. OUTCOMES Postoperatively, all patients experienced transient numbness and pain in the lower limbs, which gradually decreased over time. None of the patients experienced bleeding, severe numbness or pain, or recurrence of symptoms at 3-month follow-up. CONCLUSION Intradural extramedullary capillary hemangioma has unique morphological characteristics. Gross-total resection of the extramedullary and intramedullary components of spinal cord capillary hemangioma is recommended for patients with symptoms of spinal cord compression. Careful preoperative imaging and intraoperative decision-making may help avoid residual lesions or reoperation.
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Affiliation(s)
- Zhen Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jin Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yingchun Zhou
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- * Correspondence: Yingchun Zhou, MD, No. 1277, Jiefang Street, Jianghan District, Wuhan 430022, China (e-mail: )
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15
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Colamaria A, Sacco M, Iodice S, D’Oria S, Parbonetti G, Carbone F, de Notaris M. Intradural extramedullary cavernous hemangioma of the cervicothoracic junction: A case report and review of the literature. Surg Neurol Int 2022; 13:53. [PMID: 35242419 PMCID: PMC8888298 DOI: 10.25259/sni_964_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Intradural extramedullary cavernous hemangiomas of the spine are rare, benign lesions with only 40 published cases to date. Case Description: The authors report a rare case of a histologically diagnosed intradural extramedullary cavernous hemangioma of the spine involving the cervicothoracic junction and causing sudden gait disturbances and urinary retention in a 24-year-old male. Gross total tumor removal allowed complete spinal decompression and sensible improvement of the clinical condition with no evidence of tumor relapse at 12-month follow-up examination. Conclusion: More frequently found in the lower thoracic and lumbar spine, these tumors often cause subtle clinical manifestations including sensory and motor dysfunction secondary to nerve root compression; nonetheless, occasional cases of rapidly progressive worsening of the neurological condition with evidence of myelopathy and autonomic dysfunction have been described. In such cases, urgent surgical resection is crucial since the degree of neurological impairment and the time spanned from the onset of the symptoms are paramount for a good recovery.
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Affiliation(s)
- Antonio Colamaria
- Department of Neurosurgery, “Riuniti” Hospital, Foggia, Puglia, Italy
| | - Matteo Sacco
- Department of Neurosurgery, “Riuniti” Hospital, Foggia, Puglia, Italy
| | - Savino Iodice
- Department of Neurosurgery, “Riuniti” Hospital, Foggia, Puglia, Italy
| | - Salvatore D’Oria
- Neurosurgical Unit, Miulli Hospital, Acquaviva delle Fonti, Puglia, Italy
| | | | - Francesco Carbone
- Department of Neurosurgery, University of Foggia, Foggia, Puglia, Italy
| | - Matteo de Notaris
- Department of Neurosurgery, “Rummo” Hospital, Benevento, Campania, Italy
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16
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Capillary hemangioma of the sphenoid sinus with intrasellar and parasellar extensions. Radiol Case Rep 2021; 17:156-160. [PMID: 34820041 PMCID: PMC8599932 DOI: 10.1016/j.radcr.2021.10.011] [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: 08/23/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Capillary hemangiomas are benign vascular tumors usually diagnosed in infancy and involving skin and soft tissues. We report a rare case of an adult capillary hemangioma of the left sphenoid sinus extending into the intrasellar and parasellar regions. A 71-year-old woman presented with complaints of headaches and diplopia. Magnetic resonance imaging revealed a T2-hyperintense mass-like lesion involving the left posterior ethmoid and sphenoid sinuses and left cavernous sinus, that had extended into the intrasellar and parasellar regions. Dynamic contrast-enhanced computed tomography revealed enhancing vessel-like structures within the lesion during the arterial phase, which were observed to expand further in the late phase of the examination. This characteristic feature indicated increased vascularity, suggesting the presence of a capillary hemangioma. The patient underwent endoscopic resection via the endonasal transpterygoid approach, and the lesion was diagnosed histopathologically as a capillary hemangioma. To aid diagnosis and clinical management, radiologists should be aware of the imaging findings related to capillary hemangiomas.
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17
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Kidwell RL, Stone LE, Goodwill V, Ciacci JD. Traumatic rupture of thoracic epidural capillary hemangioma resulting in acute neurologic deficit: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21309. [PMID: 36060424 PMCID: PMC9435546 DOI: 10.3171/case21309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thoracic epidural capillary hemangioma is exceedingly rare, with only a few reported cases. The typical presentation usually includes chronic, progressive symptoms of spinal cord compression in middle-aged adults. To the authors’ knowledge, this case is the first report in the literature of acute traumatic capillary hemangioma rupture. OBSERVATIONS A 22-year-old male presented with worsening lower extremity weakness and paresthesias after a fall onto his spine. Imaging showed no evidence of spinal fracture but revealed an expanding hematoma over 24 hours. Removal of the lesion demonstrated a ruptured capillary hemangioma. LESSONS This unique case highlights a rare occurrence of traumatic rupture of a previously unknown asymptomatic thoracic capillary hemangioma in a young adult.
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Affiliation(s)
| | | | - Vanessa Goodwill
- Neuropathology, University of California, San Diego, La Jolla, California
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18
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Noureldine MHA, Rasras S, Safari H, Sabahi M, Jallo GI, Arjipour M. Spontaneous regression of multiple intracranial capillary hemangiomas in a newborn-long-term follow-up and literature review. Childs Nerv Syst 2021; 37:3225-3234. [PMID: 33481102 DOI: 10.1007/s00381-021-05053-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intracranial capillary hemangiomas (ICHs) have a natural history and behavior that is very different from intracranial cavernous malformations. The literature is not consistent as to the best management strategy for ICHs. CASE DESCRIPTION Our patient is a 40-day-old male infant who presented with progressive increase in head circumference and multiple cutaneous capillary and ICHs. Obstructive hydrocephalus necessitated urgent cerebrospinal fluid (CSF) diversion, but no other surgical intervention was pursued due to the high risk-to-benefit ratio. All intracranial lesions spontaneously regressed by 11 years of age, albeit at a slower speed than the cutaneous lesions, with no functional or cognitive sequelae. We conducted a comprehensive literature review and provided a summary of all reported ICH cases. CONCLUSION Asymptomatic patients with ICHs are best approached with close follow-up and serial imaging studies as the potential for spontaneous regression is relatively high. Patients with isolated lesions or unclear diagnoses may benefit from a stereotactic biopsy, and surgical resection should be reserved for symptomatic lesions only.
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Affiliation(s)
| | - Saleh Rasras
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hosein Safari
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadmahdi Sabahi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Mahdi Arjipour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Neurosurgery, Hamadan University of Medical Sciences, Shahid Fahmide St., Building No. 4, Hamadan, Iran.
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19
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Capillary Hemangioma: An Important Consideration in the Repertoire of Spinal Tumors. Can J Neurol Sci 2020; 48:562-564. [PMID: 33161914 DOI: 10.1017/cjn.2020.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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Santoro G, Piccirilli M, Chiarella V, Greco N, Berra LV, Santoro A. Intracranial capillary hemangiomas: literature review in pediatric and adult population. Neurosurg Rev 2020; 44:1977-1985. [PMID: 33079288 DOI: 10.1007/s10143-020-01419-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Capillary hemangiomas (CHs) of the central nervous system represent a rare diagnosed pathology. CHs are benign vascular tumors whose most common manifestations are dermal and mucous and mainly occur during childhood or adolescence, while the involvement of the central nervous system can occur in a wider age range. We conducted a PubMed research on literature published until March 2020. We only enrolled cases with histological documented presence of intracranial CH. For every case collected, we analyzed age, sex, localization, neuroimaging studies performed, the presence of extracranial CHs, symptoms, neurological deficits, extent of surgical resection (biopsy, partial or gross total), adjunct treatment received (radiotherapy, chemotherapy, Trans-Arterial Embolization TAE), and outcome. Up to March 2020, the literature review identified 52 cases to which we added the case of our personal experience. The mean age was 26 with slightly female prevalence (28 F, 25 M). The most common presenting symptom was headache (21 cases, 40%). The surgical treatment consisted of biopsy in 7 cases (13%), partial resection in 10 cases (19%), gross total resection in 31 cases (58.5%), biopsy followed by total resection in 2 cases (3%), and partial resection followed by total resection in 1 case (1.5%), and the diagnosis was obtained from an autopsy sample in 1 case (1.5%). For symptomatic lesions, surgery is a valid option to obtain histological characterization, neurological improvement, and where possible a total resection. Stereotactic radiotherapy can be used if the lesion is not surgically approachable or as an adjuvant treatment in case of partial resection, having shown good results in terms of long-term disease control.
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Affiliation(s)
- Giorgio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Manolo Piccirilli
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Vito Chiarella
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy.
| | - Nicoletta Greco
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Aldo Moro University, Bari, Italy
| | | | - Antonio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
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21
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Sudhir G, Jayabalan V, Manohar TH, Gadde S, Kumar V, Kailash K. Posttraumatic thoracic epidural capillary hemangioma - A rare case report. Surg Neurol Int 2020; 11:179. [PMID: 32754354 PMCID: PMC7395521 DOI: 10.25259/sni_567_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Capillary hemangiomas are benign vascular lesions commonly seen in subcutaneous tissues. The most common site of origin is from the vertebral body, and only a few cases of isolated lesions in thoracic epidural space, especially after trauma, have been reported in the literature. Case Description: We report a case of 63-year-old male with progressive bilateral lower limb weakness and exaggerated lower limb deep tendon reflexes without bowel and bladder involvement. His history revealed T7 fracture with paraparesis which was treated surgically, and implants were removed a year later. MRI showed an epidural lesion from T6-T8 extending into the right T7-8 foramen which showed hypointensity on T1, hyperintensity on T2, and homogenous enhancement in contrast images with severe cord compression. Laminectomy was done and the lesion was removed en bloc. Histopathological examination revealed it to be capillary hemangioma. The neurology came back to normal after 3 months. Conclusion: Although capillary hemangiomas are rare lesions, it has to be considered in the differential diagnosis of epidural space-occupying lesions which require early surgical removal to prevent a progressive and permanent neurological deficit.
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Affiliation(s)
- G Sudhir
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vignesh Jayabalan
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - T H Manohar
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Saikrishna Gadde
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Venkatesh Kumar
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Karthik Kailash
- Department of Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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22
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Koga Y, Hamada S, Saito H, Akai T, Kuroda S. Intracranial, Intra-parenchymal Capillary Hemangioma - Case Report. NMC Case Rep J 2020; 7:43-46. [PMID: 32322449 PMCID: PMC7162812 DOI: 10.2176/nmccrj.cr.2019-0145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
We report a very rare case of intracranial capillary hemangioma. This 15-year-old girl complained of pulsating headache in the temple area that aggravated with change of body positions. This headache usually lasted for 5 min and resolved without any treatment. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) strongly suggested cavernous hemangioma in the right deep parietal lobe. She underwent complete resection of the tumor through right parietal craniotomy. Postoperative course was uneventful. Histologic examinations demonstrated a densely grown numerous capillary-like vascular structure with endothelial cells, hemosiderin deposition, and hemorrhage. Intracranial, intra-parenchymal capillary hemangioma is a very rare vascular tumor or tumor like lesions. Only four cases with intracranial, intra-parenchymal capillary hemangioma were reported previously. Differential diagnosis includes other vascular tumors such as cavernous hemangioma, but it is not so easy to differentiate capillary hemangioma from other lesions. Therefore, surgical excision and histologic diagnosis would be important to diagnose it if possible.
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Affiliation(s)
- Yuichiro Koga
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Saori Hamada
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Hisayasu Saito
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Takuya Akai
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
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23
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A unique case of benign intracranial hemangioma mimicking malignant transformation. Radiol Case Rep 2018; 13:1058-1062. [PMID: 30228843 PMCID: PMC6137388 DOI: 10.1016/j.radcr.2018.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/08/2018] [Indexed: 01/31/2023] Open
Abstract
Capillary hemangiomas are rare benign vascular lesions, commonly found on scalp, face, chest, or back of a neonate or infant. Hemangiomas of the central nervous system are very rare lesions. There are only a few cases of intracranial capillary hemangioma (ICH) arising in adults reported in the literature. We present a case of 59-year-old female with intermittent recurrent headache localized in the frontal area. Magnetic resonance imaging revealed left frontal extra-axial mass with peripheral enhancement. The patient underwent complete surgical resection of the tumor. Histopathology examination of the lesion revealed well defined vascular lesion composed of closely packed plump endothelial cells lining slit-like vascular channels containing scattered red blood cells. No evidence of infiltrative brain parenchyma was seen. Ki-67 proliferative index was low, less than 2%. The final diagnosis was confirmed to be ICH by histopathology and immunohistochemistry studies. The patient has remained healthy and free of disease 39 months since her initial surgery. ICH is a benign vascular lesion which rarely occurs in the central nervous system, particularly in the intracranial region. It can mimic malignant lesions on radiologic studies. Histopathology examination is the gold standard for diagnosis. If total resection is achieved, prognosis is generally good with no evidence of recurrence.
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24
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Li J, Mao R, Feng J, Xiao L, Li J, Duan Y. Capillary hemangiomas with hemorrhage in cervicothoracic intramedullary, a case report. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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25
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Panero I, Eiriz C, Lagares A, Toldos O, Panero A, Paredes I. Intradural-Extramedullary Capillary Hemangioma with Acute Bleeding: Case Report and Literature Review. World Neurosurg 2017; 108:988.e7-988.e14. [PMID: 28823662 DOI: 10.1016/j.wneu.2017.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Capillary hemangiomas are benign vascular tumors. They are commonly founded in the vertebral bodies but very seldom in the spinal cord. The most common symptom at onset is long-lasting axial pain without neurologic deficit. In rare cases, the onset may be acute with neurological deficit due to an intratumoral hemorrhage. PATIENT AND METHODS We report a case of a 58-year-old male with a history of 15 days upper back pain triggered by a mild traumatism that evolves acutely to paraplegia and urinary and fecal retention. An urgent MR showed an intradural lesion with signs of intratumoral haemorrhage. RESULTS Urgent surgical intervention was performed and the anatomopathological results were capillary hemangioma. The symptoms of the patient improved after the surgery. CONCLUSIONS Intradural capillary hemangioma with acute intratumoral hemorrhage is a rare pathology, but it must be kept in mind because early diagnosis and treatment are key to achieve a good outcome. As far as we know, this is the first case reported of an intradural-extramedular capillary hemangioma that presents sudden neurologic deficit due to intratumoral bleeding.
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Affiliation(s)
- Irene Panero
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain.
| | - Carla Eiriz
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Oscar Toldos
- Department of Neuropathology, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Igor Paredes
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
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26
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Posttraumatic Progressive Vertebral Hemangioma Induced by a Fracture. Case Rep Surg 2017; 2017:8280678. [PMID: 28713608 PMCID: PMC5496113 DOI: 10.1155/2017/8280678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/03/2017] [Indexed: 11/24/2022] Open
Abstract
The authors present an extremely rare case of an aggressive and progressive vertebral capillary hemangioma of the lumbar spine secondary to a trauma. A 40-year-old man who complained of back and leg pain due to a hemangioma of L1 that had begun a year after the fracture of the same vertebra was subsequently operated on. Due to the profuse bleeding, only a subtotal removal was possible. Histopathological diagnosis of the lesion revealed a capillary hemangioma. Postoperative control MRI taken at eight months showed that the lesion and destruction of the L1 vertebra were progressive. A second embolization procedure was performed and this time the hemangioma was totally removed via an anterior approach and corpectomy. Fusion was achieved by Th12-L2 graft and plaque. In the fourteenth year of follow-up, he was symptom-free and radiologically clear of this lesion. We propose that progressive hemangioma is extremely rare and that its cure is possible by total surgical removal of the lesion. This case is the second extradural capillary hemangioma secondary to spinal trauma ever to have been documented in English literature. The emergence of a hemangioma in a fractured vertebra suggests that its pathogenesis can be related to the deviation of the angiogenetic pathways from the normal healing process.
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27
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Xia X, Zhang H, Gao H, Yang Y, Dai Y, Jiao Y, He J. Nearly asymptomatic intracranial capillary hemangiomas: A case report and literature review. Exp Ther Med 2017; 14:2007-2014. [PMID: 28962117 PMCID: PMC5609166 DOI: 10.3892/etm.2017.4780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 05/11/2017] [Indexed: 11/06/2022] Open
Abstract
The present study reported a nearly asymptomatic case of intracranial capillary hemangioma (ICHs), which are rare benign vascular tumors or tumor-like lesions. A 33-year-old female came to the hospital with a complaint of a slight but recurring morning headache concentrated in the left posterior occipital area. These headaches spontaneously resolved without any treatment. Computed tomography and magnetic resonance imaging revealed a mass inside the left occipital lobe. The patient refused to undergo conservative observation at home and insisted on radical therapy. Prior to surgery, an atypical meningioma or astrocytoma was suspected. A navigation-guided brain-mass resection was performed under general anesthesia and a solid mass closely associated with the tentorium cerebelli was completely resected. Histopathological analysis confirmed diagnosis of an ICH. The patient recovered well and experienced no major neurological defects, apart from an issue with the right visual field. The present study also conducted a retrospective literature review of papers published in English describing cases of intracranial capillary hemangiomas. A PubMed search identified 19 articles comprising 29 cases. The clinical symptoms of ICH are diverse and all reported cases in the literature were symptomatic. Previous studies demonstrated that diagnoses of intracranial capillary hemangioma are usually made during surgical resection by histopathological examination. Treatment for ICH remains empirical and surgery is the most common method of treatment. Patient prognosis is generally good-the majority of patients achieve long-term, event- and progression-free survival.
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Affiliation(s)
- Xiaoyu Xia
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, P.R. China
| | - Haoju Zhang
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, P.R. China
| | - Hongyan Gao
- Medical Administration Division, PLA Army General Hospital, Beijing 100700, P.R. China
| | - Yi Yang
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, P.R. China
| | - Yiwu Dai
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, P.R. China
| | - Yang Jiao
- Department of Stomatology, PLA Army General Hospital, Beijing 100700, P.R. China
| | - Jianghong He
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, P.R. China
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28
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A Case of Atopic Myelitis with Cervical Cavernous Angioma. Case Rep Med 2017; 2017:9506275. [PMID: 28757876 PMCID: PMC5512020 DOI: 10.1155/2017/9506275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022] Open
Abstract
Atopic myelitis, a type of myelitis which appears in patients with elevated serum levels of immunoglobulin E (IgE), occurs more commonly in the cervical spinal cord, but this mechanism has not yet been elucidated. Herein, we experienced a case of atopic myelitis developed during the growth of cervical cavernous angioma caused by bleeding. A 37-year-old woman suffered from hand swelling caused by a house cat licking. At the same time when cavernous angioma had grown, she experienced a numbness in her four extremities, and multifocal peritumoral hyperintense spinal cord signals were seen. The diagnosis of atopic myelitis was made because we observed significantly elevated levels of specific IgE antibody to cat dander. Symptoms disappeared immediately after steroid pulse therapy. We subsequently resected a cavernous angioma, and eosinophil invasion was found inside it. This is the first case report of atopic myelitis which developed in association with spinal cord vascular lesions. A local blood-brain barrier breakdown due to hemorrhagic lesions of the spinal cord may have contributed to the onset of atopic myelitis.
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Iacob G, Rotund B, Iancu A, Madalan A, Marinescu A, Simion G. Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report. ROMANIAN NEUROSURGERY 2017. [DOI: 10.1515/romneu-2017-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
A very rare, purely intradural, spinal, extramedullary cavernous hemangioma was fortunately discovered in a 56 years old woman, presenting with bilateral brachial paresthesia. Using conventional spin-echo T1 proton density, T2-weighted magnetic resonance and gadolinium images an intradural spinal T4-T5, an extramedullary cavernous hemangioma was discovered. The patient underwent surgery, with laminectomy and microsurgical resection followed by an uneventful postoperative clinical course. Similar as in cerebral locations a mixed signal intensity in all sequences on magnetic resonance images might be indicative of cavernous hemangioma, rendering a presumptive preoperative diagnosis of the lesion and surgical planning for a good microsurgical resection.
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Tunthanathip T, Rattanalert S, Oearsakul T, Kanjanapradit K. Spinal capillary hemangiomas: Two cases reports and review of the literature. Asian J Neurosurg 2017; 12:556-562. [PMID: 28761543 PMCID: PMC5532950 DOI: 10.4103/1793-5482.148793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hemangiomas have rarely been found in the spinal cord. A few cases of spinal capillary hemangioma have been reported since 1987. The authors reported the two cases of capillary hemangioma including the tumor at conus medullaris and the another mimicked von Hippel-Lindau disease. A 15-year-old man was presented with coccydynia and left leg pain. A magnetic resonance imaging (MRI) revealed an intradural extramedullary enhancing mass at conus medullaris. Another case, a 31-year-old man was presented with a history of familial history of brain tumor, retinal hemangioma both eyes, multiple pancreatic cyst and syringobulbia with syringohydromyelia. On MRI, a well-circumscribed intramedullary nodule was detected at C5-6 level and multiple subpial nodule along cervicothoracic spinal cord. All patients underwent surgery, and the histological diagnosis confirmed capillary hemangioma. Although rare and indistinguishable from other tumors, capillary hemangioma should be in the differential diagnosis of the spinal cord tumor.
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Affiliation(s)
- Thara Tunthanathip
- Department of Surgery, Neurosurgical Unit, Prince of Songkla University, Songkhla, Thailand
| | - Sanguansin Rattanalert
- Department of Surgery, Neurosurgical Unit, Prince of Songkla University, Songkhla, Thailand
| | - Thakul Oearsakul
- Department of Surgery, Neurosurgical Unit, Prince of Songkla University, Songkhla, Thailand
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male. Case Rep Radiol 2016; 2016:6434623. [PMID: 27747124 PMCID: PMC5055928 DOI: 10.1155/2016/6434623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/05/2016] [Indexed: 11/18/2022] Open
Abstract
Intracranial capillary hemangioma (ICH) is a rare entity, with approximately 24 reported cases in the literature. There are only three reported cases of ICH in an adult male. In this case report, we describe the fourth documented case of ICH in an adult male and, to the best of our knowledge, the first ever documented case of ICH in the posterior fossa of an adult male. We also discuss its imaging appearance and differential diagnosis.
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Abstract
STUDY DESIGN This cross-sectional study was carried out on 196 adults (98 men and 98 women), aged between 18 and 91 years. OBJECTIVE To examine whether vertebral hemangiomas (VHs) are associated with other spinal pathologies, metabolic diseases, cardiovascular diseases, cancer and past trauma, to shed light on their possible pathophysiology. SUMMARY OF BACKGROUND DATA VHs are the most common form of benign tumors in the spine. Their association with spinal and systemic pathologies has not yet been systematically studied. METHODS Clinical data were gathered from full spine CT scans and medical records. RESULTS VHs were significantly associated with disc lesions (P = 0.004), past trauma (P = 0.037), diabetes (χ = 5.179, P = 0.023), cardio-vascular diseases (χ = 8.625, P = 0.003), and cancer (χ = 5.820, P = 0.016), but not with obesity. Only medium-large size VHs were significantly associated with osteoporosis (χ = 6.695, P = 0.010). CONCLUSION The pattern of diseases related to VHs suggests a common cause for VH, namely, a disruption of vascular flow in the microvessels (accompanied by endothelium damage) within the vertebral body, eventually resulting in hypervascularization. LEVEL OF EVIDENCE 4.
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Abstract
Two cases of intracranial capillary hemangiomas (ICHs) occurring in children are presented to highlight the surgical challenges encountered with these extremely rare lesions. The author describes their clinical presentation, preoperative imaging features, intraoperative findings, and operative management. The pertinent literature is reviewed. Recommendations for preoperative planning and intraoperative management are made based on the author's experience and the literature for when ICH is considered in the differential diagnosis and encountered intraoperatively.
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Affiliation(s)
- Paul A Grabb
- Department of Neurosurgery, Children's Mercy Hospital, Kansas City, Missouri; and University of Kansas School of Medicine, Kansas City, Kansas
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Liu JJ, Lee DJ, Jin LW, Kim KD. Intradural extramedullary capillary hemangioma of the cauda equina: Case report and literature review. Surg Neurol Int 2015; 6:S127-31. [PMID: 25949855 PMCID: PMC4408617 DOI: 10.4103/2152-7806.155701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background: Capillary hemangiomas are benign vascular tumors that rarely occur in the neuraxis. When encountered in the spine, prompt diagnosis and complete resection is crucial. On rare instances, these lesions can acutely hemorrhage, leading to sudden neurological decline. To date, there are only 16 reported cases of intradural capillary hemangiomas in the cauda equina. Case Description: We report a case of an intradural extramedullary cauda equina capillary hemangioma that resulted in back pain and lower extremity motor deficit. Initial magnetic resonance (MR) imaging demonstrated a bilobular intradural L3-4 cauda equina lesion. The lesion was isointense on T1-weighted imaging, mildly hyperintense on T2-weighted images and avidly enhancing after gadolinium administration. Pathology confirmed the diagnosis of capillary hemangioma. Conclusion: Early diagnosis and treatment of this patient resulted in complete resection of the tumor and return of lower extremity motor function. Capillary hemangiomas should be considered in the differential diagnosis of cauda equina lesions. En bloc resection of these lesions is the mainstay of treatment.
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Affiliation(s)
- Jonathan J Liu
- Department of Neurological Surgery, University of California-Davis, 4860 Y. Street, Suite 3740, USA
| | - Darrin J Lee
- Department of Neurological Surgery, University of California-Davis, 4860 Y. Street, Suite 3740, USA
| | - Lee-Way Jin
- Department of Pathology, University of California-Davis, 2805 50 Street, Sacramento, CA. 95817, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California-Davis, 4860 Y. Street, Suite 3740, USA
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Intradural extramedullary capillary hemangioma in the upper thoracic spine: a review of the literature. Case Rep Orthop 2014; 2014:604131. [PMID: 25045565 PMCID: PMC4087253 DOI: 10.1155/2014/604131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/09/2014] [Indexed: 11/24/2022] Open
Abstract
Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a 12 × 8 × 20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient's symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.
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Seferi A, Alimehmeti R, Vyshka G, Bushati T, Petrela M. Case study of a spinal epidural capillary hemangioma: a 4-year postoperative follow-up. Global Spine J 2014; 4:55-8. [PMID: 24494182 PMCID: PMC3908985 DOI: 10.1055/s-0033-1354251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 07/09/2013] [Indexed: 02/08/2023] Open
Abstract
Study Design Case study. Objectives We report the case of a 58-year-old Caucasian man, who presented with a 4-month history of increasing low back pain and gait difficulty. Objective neurologic examination revealed a severe paraparetic symptomatology without any sphincter involvement. Methods Spinal magnetic resonance imaging (MRI) showed an extradural mass formation situated dorsally at the level of thoracic vertebrae T2 to T4. Results A laminectomy was performed with total removal of the mass; histology suggested a highly vascularized lesion with lobular architecture, which seems a very rare case, compatible with a capillary hemangioma. Conclusions A careful follow-up for the next 4 years, including control MRIs every postoperative year, showed a very good neurologic condition of the patient and no recurrence on imaging findings.
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Affiliation(s)
- Arsen Seferi
- Department of Neurology-Neurosurgery-Psychiatry, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Ridvan Alimehmeti
- Department of Neurology-Neurosurgery-Psychiatry, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Gentian Vyshka
- Biomedical and Experimental Department, Faculty of Medicine, University of Tirana, Tirana, Albania
- Address for correspondence Gentian Vyshka, MD Lagja 1, Rr. Kostaq CipoPall. 2/19, TiranaAlbania
| | - Teona Bushati
- Department of Pathological Anatomy, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Mentor Petrela
- Department of Neurology-Neurosurgery-Psychiatry, Faculty of Medicine, University of Tirana, Tirana, Albania
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Wu L, Deng X, Yang C, Xu Y. Intramedullary spinal capillary hemangiomas: clinical features and surgical outcomes: clinical article. J Neurosurg Spine 2013; 19:477-84. [PMID: 23971764 DOI: 10.3171/2013.7.spine1369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intramedullary capillary hemangiomas are exceedingly rare lesions in the spinal cord, and have been previously reported in the literature as case reports. The authors review their experience in 5 surgically treated patients with intramedullary capillary hemangiomas and discuss the clinical features, radiological findings, and surgical outcomes. METHODS Clinical and imaging data of 5 patients with intramedullary spinal capillary hemangiomas treated at a single institution were retrospectively analyzed. RESULTS There were 4 men and 1 woman, and their ages ranged from 18 to 63 years (mean 47.2 years). The thoracic cord was affected in 4 patients, and the cervicothoracic cord in 1 patient. Four patients underwent a gross-total resection. One patient initially underwent a subtotal removal and then underwent a second surgery due to enlargement of the residual lesion. Long-term neurological function was improved in all patients and MRI showed no tumor recurrence. CONCLUSIONS Capillary hemangiomas should be considered in the differential diagnosis of intramedullary spinal vascular lesions. Complete resection is the treatment of choice for these lesions. When total resection cannot be achieved, subtotal or even partial removal of the tumor is advised and repeat removal of the lesion is indicated when residual tumor regrowth is associated with neurological deterioration.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yeo KK, Puscasiu E, Keating RF, Rood BR. Durable response of intracranial cellular hemangioma to bevacizumab and temozolomide. J Neurosurg Pediatr 2013; 11:682-6. [PMID: 23540527 DOI: 10.3171/2013.2.peds12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cellular hemangioma is a subtype of hemangioma that is associated with cellular immaturity and the potential for recurrence. Intracranial location of these lesions is extremely rare, and definitive treatment often requires radical neurosurgical resection. The authors report a case of a 12-year-old boy with a subtemporal cellular hemangioma. He underwent gross-total resection of the tumor, but within 1.5 months the tumor recurred, necessitating a second resection. Because of its proximity to vascular structures, only subtotal resection was possible. Repeat MRI 1 month after the second surgery showed significant tumor recurrence. Given the tumor's demonstrated capacity for recurrence and its proximity to the vein of Labbé and sigmoid sinus, further resection was not indicated. In an effort to limit radiation therapy for this young patient, treatment with bevacizumab and temozolomide was chosen and achieved a complete response that has proven durable for 36 months after cessation of therapy. This is the first report of the successful use of chemotherapy to treat an intracranial hemangioma, a rare condition with limited therapeutic options.
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Affiliation(s)
- Kee Kiat Yeo
- Department of Pediatrics, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Kaneko Y, Yamabe K, Abe M. Rapid regrowth of a capillary hemangioma of the thoracic spinal cord. Neurol Med Chir (Tokyo) 2013; 52:665-9. [PMID: 23006883 DOI: 10.2176/nmc.52.665] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old man presented with a 2-week history of progressive gait disturbance. Neurological examinations showed mild weakness in his lower extremities and depreciation of deep sensation. Magnetic resonance (MR) imaging showed an intradural extramedullary enhanced lesion at the levels of the T10 and T11 vertebrae. Laminectomy of the T10 and T11 vertebrae was performed, and the vascular tumor on the spinal cord surface was completely resected. Histological analysis indicated that the lesion was a capillary hemangioma with an elevated proliferative index. Postoperatively, the patient showed rapid motor and sensory improvement. However, 6 months after the operation, MR imaging showed regrowth of the tumor although the clinical symptoms of the patient had not deteriorated. The patient has shown no tumor regrowth 9 years after the second operation. Capillary hemangiomas in the skin and soft tissues are often associated with high proliferative activity, and recurrence/regrowth is not infrequent. On the other hand, recurrence/regrowth of capillary hemangioma in the neuraxis after tumor resection has rarely been observed, even in cases of incomplete resection. The present case illustrates the treatment of recurrent capillary hemangioma of the spinal cord.
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Affiliation(s)
- Yoichi Kaneko
- Department of Neurosurgery, Imamura Hospital, Tosu, Saga, Japan
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Cutaneous and leptomeningeal hemangiomas with impressive benign evolution. Pediatr Neurol 2013; 48:73-5. [PMID: 23290026 DOI: 10.1016/j.pediatrneurol.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/06/2012] [Indexed: 11/22/2022]
Abstract
We describe an infant with cutaneous and leptomeningeal diffuse hemangiomata. Clinical facial anomalies were evident at birth. Routine transfontanellar ultrasonography revealed very diffuse leptomeningeal hemangioma. Magnetic resonance imaging during the first days of age confirmed vascular lesions. The patient was otherwise normal, and was monitored at ages 3.5, 9, and 18 months. Rapid resolution of the hemangioma occurred within 1 year. The infant did not present with persistent embryonic arteries, a posterior fossa, or other malformations typically reported in Pascual-Castroviejo type II syndrome. However, the characteristic skin color, leptomeningeal hemangioma, and rapid involution prompted the diagnosis of Pascual-Castroviejo II syndrome in its wider, benign spectrum.
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Zheng SP, Ju Y, You C. Giant intracranial capillary hemangioma in a 3-year-old child: Case report and literature review. Clin Neurol Neurosurg 2012; 114:1270-3. [DOI: 10.1016/j.clineuro.2012.02.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 11/29/2022]
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Morace R, Marongiu A, Vangelista T, Galasso V, Colonnese C, Giangaspero F, Innocenzi G, Esposito V, Cantore G. Intracranial Capillary Hemangioma: A Description of Four Cases. World Neurosurg 2012; 78:191.E15-21. [DOI: 10.1016/j.wneu.2011.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 05/30/2011] [Accepted: 09/04/2011] [Indexed: 12/19/2022]
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Phi JH, Kim SK, Cho A, Kim DG, Paek SH, Park SH, Wang KC. Intracranial capillary hemangioma: extra-axial tumorous lesions closely mimicking meningioma. J Neurooncol 2012; 109:177-85. [DOI: 10.1007/s11060-012-0884-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 04/16/2012] [Indexed: 12/26/2022]
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John SG, Pillai U, Lacasse A. Intracranial capillary hemangioma mimicking a dissociative disorder. Clin Pract 2012; 2:e35. [PMID: 24765434 PMCID: PMC3981297 DOI: 10.4081/cp.2012.e35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/31/2012] [Accepted: 02/09/2012] [Indexed: 01/19/2023] Open
Abstract
Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS). Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient focal neurological deficits and behavioral abnormalities mimicking Ganser's syndrome. Patient underwent total excision of the vascular malformation, resulting in complete resolution of his symptoms.
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Affiliation(s)
- Santosh G John
- Department of Internal Medicine, St. Marys health Center, St. Louis, Missouri, USA
| | - Unnikrishnan Pillai
- Department of Internal Medicine, St. Marys health Center, St. Louis, Missouri, USA
| | - Alexander Lacasse
- Department of Internal Medicine, St. Marys health Center, St. Louis, Missouri, USA
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Philpott C, Wray A, MacGregor D, Coleman L. Dural infantile hemangioma masquerading as a skull vault lesion. AJNR Am J Neuroradiol 2011; 33:E85-7. [PMID: 22116108 DOI: 10.3174/ajnr.a2752] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe a case of intracranial dural IH initially diagnosed as a primary skull vault lesion hemangioma due to associated focal hyperostosis. Histopathologic examination of the dural component confirmed IH. The case is discussed in the context of IH within the neural axis.
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Affiliation(s)
- C Philpott
- Department of Radiology, Royal Children’s Hospital Melbourne, Australia.
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Shilton H, Goldschlager T, Kelman A, Xenos C. Delayed post-traumatic capillary haemangioma of the spine. J Clin Neurosci 2011; 18:1546-7. [PMID: 21871810 DOI: 10.1016/j.jocn.2011.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
Abstract
Capillary haemangiomas are well-circumscribed aggregates of closely packed, thin-walled capillaries separated by connective tissue stroma. In subcutaneous tissue they are termed pyogenic granuloma and commonly follow trauma. They rarely occur in the spine. We present a 43-year-old woman with a 6-week history of thoracic myelopathy and back pain on a background of T7 and T8 vertebral compression fractures from a motor vehicle accident 10 years previously. MRI demonstrated a posteriorly based extradural homogeneously enhancing mass at this level. The lesion was resected and diagnosed histopathologically as a capillary haemangioma. The patient's symptoms resolved and she made an uneventful recovery. The literature is reviewed and the possible pathogenesis is discussed.
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Affiliation(s)
- Hamish Shilton
- Department of Neurosurgery, Southern Health, 246 Clayton Road, Clayton 3168, Victoria, Australia.
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Abstract
Multiple vascular patterns are presented in tumors of the central nervous system (CNS), including microvascular hyperplasia, branching capillaries, numerous capillaries without definite pattern, hyalinized vessels, and angiomatous area. These vascular patterns play important roles in pathological diagnosis of brain tumors. Because of insufficient recognition of the significance of the various vascular patterns, only a few of them have been applied in pathological diagnosis, leading to missed diagnosis and diagnostic errors. Microvascular hyperplasia can present in multiple brain tumors but display different diagnostic values. Otherwise, varied brain tumors characterized by branching capillaries or vascular pattern mimicking branching capillaries should be given careful consideration. Therefore, a familiarity of these tumors and their vascular pattern is essential for general pathologists. This study reviews the value of various kinds of vascular patterns for pathological diagnosis of brain tumors, constructs a framework for better understanding, and provides a novel perspective for general pathologists.
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Affiliation(s)
- Jing Zhou
- Department of Pathology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
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Chung SK, Nam TK, Park SW, Hwang SN. Capillary hemangioma of the thoracic spinal cord. J Korean Neurosurg Soc 2010; 48:272-5. [PMID: 21082058 DOI: 10.3340/jkns.2010.48.3.272] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 05/27/2010] [Accepted: 08/09/2010] [Indexed: 11/27/2022] Open
Abstract
Capillary hemangiomas are common soft tissue tumors on the skin or mucosa of the head and neck in the early childhood, but very rare in the neuraxis. A 47-year-old man presented with one month history of back pain on the lower thoracic area, radiating pain to both legs, and hypesthesia below T7 dermatome. Thoracic spine MRI showed 1×1.3×1.5 cm, well-defined intradural mass at T6-7 disc space level, which showed isointensity to spinal cord on T1, heterogeneous isointensity on T2-weighted images, and homogeneous strong enhancement. The patient underwent T6-7 total laminotomy, complete tumor removal and laminoplasty. Histologically, the mass showed a capsulated nodular lesion composed of capillary-sized vascular channels, which were tightly packed into nodules separated by fibrous septa. These features were consistent with capillary hemangioma.
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Affiliation(s)
- Sung-Kyun Chung
- Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Seoul, Korea
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50
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Abstract
Intracranial capillary hemangiomas are extremely rare. Only 14 histologically proven cases have been reported in the literature. A 59-year-old-female presented with a severe headache for 3 weeks. Brain MRI revealed a homogeneous contrast enhancing round mass lesion in the pituitary stalk and infundibular recess. We performed endoscopic biopsy. In the operative field, a reddish, well-circumscribed mass from the infundibular recess protruded into the third ventricle and it was separated from the optic chiasm. The tumor appeared a highly vascular. Histopathological examination demonstrated an aggregation of thin-walled capillaries, consistent with capillary hemangioma.
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