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

Year 2015, Volume: 49 Issue: 4, 459 - 464, 19.08.2015

Yaşar Bayri Murat Ekşi Demet Yalçınkaya Koç Deniz Konya

https://doi.org/10.3944/AOTT.2015.13.0090

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

References

• Talacchi A, Spinnato S, Alessandrini F, Iuzzolino P, Bri- colo A. Radiologic and surgical aspects of pure spinal epi- dural cavernous angiomas. Report on 5 cases and review of the literature. Surg Neurol 1999;52:198–203.
• Saringer W, Nöbauer I, Haberler C, Ungersböck K. Ex- traforaminal, thoracic, epidural cavernous haemangioma: case report with analysis of magnetic resonance imaging characteristics and review of the literature. Acta Neuro- chir (Wien) 2001;143:1293–7.
• Rovira A, Capellades J, Zauner M, Bella R, Rovira M. Lumbar extradural hemangiomas: report of three cases. AJNR Am J Neuroradiol 1999;20:27–31.
• Aoyagi N, Kojima K, Kasai H. Review of spinal epidur- al cavernous hemangioma. Neurol Med Chir (Tokyo) 2003;43:471–6.
• Lee JW, Cho EY, Hong SH, Chung HW, Kim JH, Chang KH, et al. Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation. AJNR Am J Neuroradiol 2007;28:1242–8.
• Nagi S, Megdiche H, Bouzaïdi K, Haouet S, Khouja N, Douira W, et al. Imaging features of spinal epidural cav- ernous malformations. J Neuroradiol 2004;31:208–13.
• Zevgaridis D, Büttner A, Weis S, Hamburger C, Reulen HJ. Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature. J Neurosurg 1998;88:903–8.
• Russell DS, Rubinstein LJ. Tumour and tumour-like le- sions of maldevelopmental origin. In: Russell DS, Rubin- stein LJ, editors. Pathology of tumours of the central ner- vous system. Baltimore: Williams&Wilkins 1989:727–36.
• Globus JH, Doshay LJ. Venous dilatations and other in- traspinal vessel alterations, including true angiomata, with signs and symtoms of cord compression. A report of four cases with a review of the literature. Surg Gynecol Obstet 1929;48:345–66.
• D’Andrea G, Ramundo OE, Trillò G, Roperto R, Isidori A, Ferrante L. Dorsal foramenal extraosseous epidural cavernous hemangioma. Neurosurg Rev 2003;26:292–6.
• Hatiboglu MA, Iplikcioglu AC, Ozcan D. Epidural spi- nal cavernous hemangioma. Neurol Med Chir (Tokyo) 2006;46:455–8.
• Khalatbari MR, Abbassioun K, Amirjmshidi A. Solitary spinal epidural cavernous angioma: report of nine surgi- cally treated cases and review of the literature. Eur Spine J 2013;22:542–7.
• Akiyama M, Ginsberg HJ, Munoz D. Spinal epidural cav- ernous hemangioma in an HIV-positive patient. Spine J 2009;9:e6–8.
• Minh NH. Cervicothoracic spinal epidural cavernous hemangioma: case report and review of the literature. Surg Neurol 2005;64:83–5.
• Jo BJ, Lee SH, Chung SE, Paeng SS, Kim HS, Yoon SW, et al. Pure epidural cavernous hemangioma of the cervical spine that presented with an acute sensory deficit caused by hemorrhage. Yonsei Med J 2006;47:877–80.
• Sanghvi D, Munshi M, Kulkarni B, Kumar A. Dorsal spi- nal epidural cavernous hemangioma. J Craniovertebr Junc- tion Spine 2010;1:122–5.
• Santoro A, Piccirilli M, Bristot R, di Norcia V, Salvati M, Delfini R. Extradural spinal cavernous angiomas: report of seven cases. Neurosurg Rev 2005;28:313–9.
• Sarikaya-Seiwert S, Gierga K, Wessalowski R, Steiger HJ, Hänggi D. Solitary spinal epidural cavernous angiomas in children presenting with acute neurological symptoms caused by hemorrhage. J Neurosurg Pediatr 2010;5:89–93.
• Satpathy DK, Das S, Das BS. Spinal epidural cavernous hemangioma with myelopathy: a rare lesion. Neurol India 2009;57:88–90.
• Sohn MJ, Lee DJ, Jeon SR, Khang SK. Spinal radiosurgi- cal treatment for thoracic epidural cavernous hemangioma presenting as radiculomyelopathy: technical case report. Neurosurgery 2009;64:E1202–3.
• Tekkök IH, Akpinar G, Güngen Y. Extradural lumbosa- cral cavernous hemangioma. Eur Spine J 2004;13:469–73.
• Iglesias S, Ayerbe J, Sarasa JL, Sousa P, Torres C, Ruiz- Barnés P. Dumbbell-shaped spinal epidural cavernous an- gioma. Case report and review of the literature. [Article in Spanish] Neurocirugia (Astur) 2008;19:248–53. [Ab- stract]
• Floeth F, Riemenschneider M, Herdmann J. Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: a rare cause of acute lumbal radiculopathy. Eur Spine J 2010;19 Suppl 2:193–6.
• Lam RL, Roulhac GE, Erwin HJ. Hemangioma of the spi- nal canal and pregnancy. J Neurosurg 1951;8:668–71.
• Padovani R, Poppi M, Pozzati E, Tognetti F, Querzola C. Spinal epidural hemangiomas. Spine (Phila Pa 1976) 1981;6:336–40.
• Chamberlain MC, Tredway TL. Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep 2011;11:320–8.
• Palmbach M, Hoffmann W, Grodd W, Postler E, Voigt K. Extraosseous, epidural tumour spread of multiple my- eloma. Eur J Radiol 1996;22:146–8.
• Saito T, Terada K, Tsuchiya K, Oda Y, Tsuneyoshi M, Iwa- moto Y. Lymphangioma presenting as a dumbbell tumor in the epidural space of the lumbar spine. Spine (Phila Pa 1976) 1999;24:74–6.
• Harrison MJ, Eisenberg MB, Ullman JS, Oppenheim JS, Camins MB, Post KD. Symptomatic cavernous malfor- mations affecting the spine and spinal cord. Neurosurgery 1995;37:195–205.