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

Spinal epidural hemangioma, mostly cavernous, is a rare lesion with many radiological mimics that has diagnostic difficulty. They can extend from one to multiple vertebral levels and may or may not be associated with vertebral hemangiomas. We are reporting a case of young adult presenting with features of compressive myelopathy. Plain and contrast-enhanced magnetic resonance imaging showed a large spinal epidural lesion extending from C7 to D10 vertebral levels with extension into adjacent neural foramina and paravertebral spaces. There were also signal changes in bodies and posterior elements of dorsal vertebrae. A provisional diagnosis of lymphoma was made. The patient was operated for decompression and histopathological diagnosis of cavernous hemangioma was made. As in our case, a review of literature shows that epidural cavernous hemangioma of spine may extend to multiple vertebral levels and difficult to diagnose on pre-operative imaging. However, such a long segment epidural cavernous hemangioma has not been reported in literature. Furthermore, we should be aware of these rare lesions to include it in our differential diagnosis the spinal epidural lesions for early diagnosis and management.

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Ventral “Spinal Epidural Meningeal Cysts”—Not Epidural and Not Cysts? Case Series and Review of the Literature

Neurosurgery ◽

10.1227/neu.0b013e318230968c ◽

2011 ◽

Vol 70 (2) ◽

pp. 320-328 ◽

Cited By ~ 10

Author(s):

Bret Gene Ball ◽

Patrick H. Luetmer ◽

Caterina Giannini ◽

Bahram Mokri ◽

Neeraj Kumar ◽

...

Keyword(s):

Relevant Literature ◽

Case Series ◽

Signs And Symptoms ◽

Spinal Pain ◽

Neurological Deficits ◽

Definitive Treatment ◽

Dural Defect ◽

Computed Tomographic Myelography ◽

Meningeal Cysts ◽

Spinal Epidural

Abstract BACKGROUND: Ventral spinal epidural meningeal cysts are rare entities for which the pathogenesis is poorly understood. OBJECTIVE: We present the clinical, radiographic, surgical, and pathologic findings of 4 patients with extensive ventral spinal epidural meningeal cysts and review the relevant literature. In addition, we discuss a suspected mechanism for pathogenesis. METHODS: Four patients with anterior spinal epidural meningeal cysts are retrospectively reviewed. RESULTS: Ventral spinal epidural meningeal cysts are often large, extending on average from C2 to L1 in our series. Patients typically present with a prolonged course of symptoms and signs, including segmental muscle weakness and atrophy, subtle myelopathy, mild to moderate spinal pain, and headache. Histopathologic analysis of the cyst wall demonstrates collagenous tissue consistent with dura but without arachnoid features. Dynamic computed tomographic myelography is the study of choice for localization of the primary dural defect. Patient symptoms and neurological deficits routinely improve after appropriate surgical intervention. CONCLUSION: Diverse signs and symptoms herald the presentation of ventral spinal meningoceles. Intraoperative, radiographic, and pathological findings are all suggestive of an intradural dissection as the etiology. Hence, they may be more appropriately named “ventral spinal intradural dissecting meningoceles.” Definitive treatment involves identification and obliteration of the dural defect.

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