Spinal epidural cavernous angioma: two case reports and review of the literature

Abstract

Cavernous angiomas are vascular malformations that occur most frequently in the supratentorial area of the central nervous system (CNS). Spinal epidural occurrence is rare. This article describes 2 cases of spinal epidural cavernous angioma. The lesions were hypo- to isointense on T1-weighted magnetic resonance images (MRIs) and hyperintense on T2-weighted images. Both were enhanced homogenously with intravenous contrast. Total resection was achieved in both cases, and the lesions were histopathologically diagnosed as cavernous angiomas. The patients’ symptoms regressed postsurgery. Although the MRI features of cavernous angiomas are well known, spinal epidural occurrence is rare and many differential diagnoses have similar clinical and imaging findings. It is important to definitively diagnose these lesions prior to surgery in order to prevent possible intraoperative complications such as massive bleeding and to maximize chances for complete resection. In addition to case descriptions, this article includes a thorough literature review to raise clinical awareness about this well-known but rare spinal entity.

Keywords

• Cavernous angioma
• epidural
• intraspinal extradural tumor

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Öz

Kavernöz anjiomlar, en çok merkezi sinir sisteminde supratentoriyel alanda saptanan, damarsal mal- formasyonlardır. Omurga epidural alanda oldukça nadir olarak tespit edilirler. Makalede, omurga epi- dural alan yerleşimli iki kavernöz anjiom olgusu anlatılmaktadır. Lezyonlar T1-ağırlıklı incelemede izointens, T2-ağırlıklı incelemede hiperintenstiler. Damardan verilen kontrast madde sonrası, lezyon- ların her ikisi de homojen olarak boyandı. Lezyonlar cerrahi olarak rezeke edildi. Patolojik tanıları kavernöz anjiomdu. Hastaların, ameliyatlardan sonra semptomları iyileşti. Kavernöz anjiomların rad- yolojik özellikleri bilinmekle beraber, omurga epidural alan yerleşimleri nadirdir; ve bu bölge için ayrıcı tanıda benzer klinik ve radyolojik özelliklere sahip bir çok patoloji mevcuttur. Ameliyat esnasında gelişebilecek komplikasyonları (örneğin masif kanama gibi) engelleyebilmek ve cerrahi rezeksiyonu ta- mamlayabilmek için kesin tanının önceden konulması önemlidir. Bu yazıda, olgu sunumlarıyla beraber detaylı literatür taraması yapılarak, bu iyi bilinen; fakat nadir olan omurga patolojisi sunulmaktadır

Anahtar Kelimeler

• Kavernöz anjiom; epidural; omurga-içi ekstradural tümör

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