Aoyagi Norio, Kojima Kuniaki, Kasai Hirohiko
Department of Neurosurgery of Moriyama Hospital, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2003 Oct;43(10):471-5; discussion 476. doi: 10.2176/nmc.43.471.
The characteristics of spinal epidural cavernous hemangioma without primary origin in the vertebral bone were evaluated in 54 patients including our new case. The 36 male and 18 female patients were aged 5 to 78 years (mean 47 years). Most lesions were in the thoracic spine (80%) and on the dorsal side of the spinal cord (93%). The clinical course was mostly slowly progressive, with myelopathy in 33% at onset and 83% at admission. The lesion appeared isointense to the spinal cord on T1-weighted imaging, and isointense or slightly hypointense to the cerebrospinal fluid on T2-weighted imaging. Lesion without hemorrhage showed prominent homogeneous enhancement after administration of gadolinium-diethylenetriaminepenta-acetic acid because of the sinusoidal channel structure. Heterogeneous enhancement was caused by hematoma and/or post-hemorrhagic degeneration. The differential diagnosis of this disease includes metastatic tumor, Ewing's sarcoma, chordoma, eosinophilic granuloma, sarcoidosis, lipoma, hypertrophy of the posterior longitudinal ligament or the ligamentum flavum, meningioma, and neurinoma. The relationships between clinical course and surgery or outcome suggest that early diagnosis and total removal of the lesion before massive lesional bleeding occurs are necessary for a good outcome.
我们对包括新病例在内的54例无椎体原发性起源的脊髓硬膜外海绵状血管瘤的特征进行了评估。36例男性和18例女性患者年龄为5至78岁（平均47岁）。大多数病变位于胸椎（80%）且在脊髓背侧（93%）。临床病程大多为缓慢进展，起病时33%有脊髓病，入院时83%有脊髓病。病变在T1加权成像上与脊髓信号等强，在T2加权成像上与脑脊液信号等强或略低。无出血的病变在给予钆喷酸葡胺后因窦状隙通道结构而显示明显均匀强化。不均匀强化由血肿和/或出血后变性引起。本病的鉴别诊断包括转移瘤、尤因肉瘤、脊索瘤、嗜酸性肉芽肿、结节病、脂肪瘤、后纵韧带或黄韧带肥厚、脑膜瘤和神经鞘瘤。临床病程与手术或预后的关系提示，早期诊断并在病变大量出血前彻底切除病变对于良好预后是必要的。
