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Clinical features and long-term surgical outcomes of pure spinal epidural cavernous hemangioma—report of 23 cases

Abstract

Background

Pure spinal epidural cavernous malformation (CM) is a rare hypervascular disease that is easily misinterpreted as other imaging-similar epidural lesions. The demographic characteristics, therapeutic strategies, and surgical outcomes associated with this vascular entity remains unclear.

Methods

A retrospective review of patients with pathologically proven, pure epidural CM from 2001 to 2018 was conducted. All data that included clinical manifestations, radiographic features, and treatment modalities were analyzed.

Results

Twenty-three consecutive patients with an average age of 51.5 ± 8.4 years old (range 38–70 years old) were included; of these, 52.2% were female patients. Clinical manifestation included chronic progressive nerve root disturbance syndrome in 7 patients (30.4%) and myelopathy in 16 patients (69.6%). The CM level was predominately thoracic (n = 14, 60.9%) or lumbar (n = 6, 26.1%), with the dorsal epidural space (n = 14, 60.9%) the most common site. The initial clinical diagnoses were schwannoma (n = 11, 52.2%), meningioma (n = 5, 21.7%), angioma (n = 3, 13.1%), recurrent CMs (n = 2, 8.7%), and metastatic tumor (n = 1, 4.3%). Fifteen lesions (65.2%) were isointense on T1-weighted images, and all lesions were hyperintense on T2-weighted images, with homogenously strong enhancement observed in 17 lesions (73.9%). Total resection was achieved in 18 patients (78.3%) and usually resulted in excellent clinical outcomes (n = 21, 91.3%). No patients experienced recurrence of symptoms, and lesion relapse during follow-up.

Conclusion

Total surgical removal of epidural CM can usually achieve satisfactory outcomes in patients with a chronic clinical course and should be recommended. Subtotal removal of tumors can also benefit patients, and guaranteed a long recurrent free time after surgery. A good preoperative neurological condition usually leads to good outcomes.

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References

  1. Aoyagi N, Kojima K, Kasai H (2003) Review of spinal epidural cavernous hemangioma. Neurol Med Chir (Tokyo) 43(10):471–475 discussion 476

    Article  Google Scholar 

  2. Appiah GA, Knuckey NW, Robbins PD (2001) Extradural spinal cavernous haemangioma: case report and review of the literature. J Clin Neurosci 8(2):176–179

    CAS  Article  Google Scholar 

  3. Bayri Y, Eksi MS, Yalcinkaya Koc D, Konya D (2015) Spinal epidural cavernous angioma: two case reports and review of the literature. Acta Orthop Traumatol Turc 49(4):459–464

    PubMed  Google Scholar 

  4. Carlier R, Engerand S, Lamer S et al (2000) Foraminal epidural extra osseous cavernous hemangioma of the cervical spine: a case report. Spine (Phila Pa 1976) 25(5):629–631

    CAS  Article  Google Scholar 

  5. Caruso G, Galarza M, Borghesi I et al (2007) Acute presentation of spinal epidural cavernous angiomas: case report. Neurosurgery 60(3):E575–E576 discussion E576

    Article  Google Scholar 

  6. Cossandi C, Fanti A, Gerosa A et al (2018) Rare case of dumbbell-shaped spinal cavernous Hemangioma and literature review. World Neurosurg 120:181–184

    Article  Google Scholar 

  7. D'Andrea G, D'Andrea G, Ramundo OE, Trillo G et al (2003) Dorsal foramenal extraosseous epidural cavernous hemangioma. Neurosurg Rev 26(4):292–296

    Article  Google Scholar 

  8. Daneyemez M, Sirin S, Duz B (2000) Spinal epidural cavernous angioma: case report. Minim Invasive Neurosurg 43(3):159–162

    CAS  Article  Google Scholar 

  9. Esene IN, Ashour AM, Marvin E et al (2016) Pure spinal epidural cavernous hemangioma: a case series of seven cases. J Craniovertebr Junction Spine 7(3):176–183

    Article  Google Scholar 

  10. Frankel HL, Hancock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I Paraplegia 7(3):179–192

    CAS  PubMed  Google Scholar 

  11. Gencpinar P, Acikbas SC, Nur BG et al (2014) Epidural capillary hemangioma: a review of the literature. Clin Neurol Neurosurg 126:99–102

    Article  Google Scholar 

  12. Goyal A, Singh AK, Gupta V, Tatke M (2002) Spinal epidural cavernous haemangioma: a case report and review of literature. Spinal Cord 40(4):200–202

    CAS  Article  Google Scholar 

  13. Hakan T, Demir M, Aker F, Berkman M (2007) Pregnancy-related spinal epidural capillary-cavernous haemangioma: magnetic resonance imaging and differential diagnosis. Australas Radiol 51 Spec No:B6–B9

    Article  Google Scholar 

  14. Hatiboglu MA, Iplikcioglu AC, Ozcan D (2006) Epidural spinal cavernous hemangioma. Neurol Med Chir (Tokyo) 46(9):455–458

    Article  Google Scholar 

  15. Huang KT, McAvoy M, Helgager J et al (2018) Spinal hemangioma mimicking a dumbbell-shaped schwannoma: case report and review of the literature. J Clin Neurosci 50:160–162

    Article  Google Scholar 

  16. Jeong WJ, Choi I, Seong HY, Roh SW (2015) Thoracic extradural cavernous hemangioma mimicking a dumbbell-shaped tumor. J Korean Neurosurg Soc 58(1):72–75

    CAS  Article  Google Scholar 

  17. Khalatbari MR, Abbassioun K, Amirjmshidi A (2013) Solitary spinal epidural cavernous angioma: report of nine surgically treated cases and review of the literature. Eur Spine J 22(3):542–547

    Article  Google Scholar 

  18. Khalatbari MR, Hamidi M, Moharamzad Y (2013) Acute presentation of solitary spinal epidural cavernous angioma in a child. J Coll Physicians Surg Pak 23(5):364–366

    PubMed  Google Scholar 

  19. Kim KH, Song SW, Lee SE, Lee SH (2012) Spinal epidural arteriovenous hemangioma mimicking lumbar disc herniation. J Korean Neurosurg Soc 52(4):407–409

    Article  Google Scholar 

  20. Kivelev J, Niemela M, Hernesniemi J (2010) Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature. J Neurosurg Spine 13(4):524–534

    Article  Google Scholar 

  21. Lee JW, Cho EY, Hong SH et al (2007) Spinal epidural hemangiomas: various types of MR imaging features with histopathologic correlation. AJNR Am J Neuroradiol 28(7):1242–1248

    CAS  Article  Google Scholar 

  22. Li TY, Xu YL, Yang J et al (2015) Primary spinal epidural cavernous hemangioma: clinical features and surgical outcome in 14 cases. J Neurosurg Spine 22(1):39–46

    Article  Google Scholar 

  23. McCormick PC, Michelsen WJ, Post KD et al (1988) Cavernous malformations of the spinal cord. Neurosurgery 23(4):459–463

    CAS  Article  Google Scholar 

  24. Muhmer M, Bostelmann R, Sarikaya-Seiwert S et al (2014) Clinical and radiological presentation of spinal epidural haemangiomas: clinical series in a tertiary care centre during a 10-year period. Eur Spine J 23(2):404–410

    Article  Google Scholar 

  25. Nagi S, Megdiche H, Bouzaidi K et al (2004) Imaging features of spinal epidural cavernous malformations. J Neuroradiol 31(3):208–213

    CAS  Article  Google Scholar 

  26. Pojskic M, Zbytek B, Mutrie CJ, Arnautovic KI (2018) Spinal dumbbell epidural hemangioma: two stage/same sitting/same position posterior microsurgical and transthoracic endoscopic resection - case report and review of the literature. Acta Clin Croat 57(4):797–808

    PubMed  PubMed Central  Google Scholar 

  27. Rigamonti D, Johnson PC, Spetzler RF et al (1991) Cavernous malformations and capillary telangiectasia: a spectrum within a single pathological entity. Neurosurgery 28(1):60–64

    CAS  Article  Google Scholar 

  28. Sarikaya-Seiwert S, Gierga K, Wessalowski R et al (2010) Solitary spinal epidural cavernous angiomas in children presenting with acute neurological symptoms caused by hemorrhage. J Neurosurg Pediatr 5(1):89–93

    Article  Google Scholar 

  29. Shin JH, Lee HK, Rhim SC et al (2001) Spinal epidural cavernous hemangioma: MR findings. J Comput Assist Tomogr 25(2):257–261

    CAS  Article  Google Scholar 

  30. Simard JM, Garcia-Bengochea F, Ballinger WE et al (1986) Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 18(2):162–172

    CAS  Article  Google Scholar 

  31. Sohn MJ, Lee DJ, Jeon SR, Khang SK (2009) Spinal radiosurgical treatment for thoracic epidural cavernous hemangioma presenting as radiculomyelopathy: technical case report. Neurosurgery 64(6):E1202–E1203 discussion E1203

    Article  Google Scholar 

  32. Yunoki M, Suzuki K, Uneda A, Yoshino K (2015) A case of dumbbell-shaped epidural cavernous angioma in the lumbar spine. Surg Neurol Int 6(Suppl 10):S309–S312

    Article  Google Scholar 

  33. Zevgaridis D, Medele RJ, Hamburger C et al (1999) Cavernous haemangiomas of the spinal cord. A review of 117 cases. Acta Neurochir 141(3):237–245

    CAS  Article  Google Scholar 

  34. Zhong W, Huang S, Chen H et al (2012) Pure spinal epidural cavernous hemangioma. Acta Neurochir 154(4):739–745

    Article  Google Scholar 

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Acknowledgments

Hospitals in the article refer to the Chinese PLA General Hospital.

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Correspondence to Xinguang Yu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee by the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Zhang, L., Qiao, G., Shang, A. et al. Clinical features and long-term surgical outcomes of pure spinal epidural cavernous hemangioma—report of 23 cases. Acta Neurochir 162, 2915–2921 (2020). https://doi.org/10.1007/s00701-020-04358-x

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Keywords

  • Cavernous hemangiomas
  • Spinal cord
  • Epidural
  • Imaging features
  • Prognosis