Yunoki Masatoshi, Suzuki Kenta, Uneda Atsuhito, Yoshino Kimihiro
Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan.
Surg Neurol Int. 2015 Jun 25;6(Suppl 10):S309-12. doi: 10.4103/2152-7806.159378. eCollection 2015.
Most spinal cavernous haemangiomas occur in the vertebral body and purely extradural cavernous hemangiomas without any vertebral body involvement is rare and account for only 4% of all extradural spinal tumors. Dumbbell-shaped spinal cavernous angioma is extremely rare, only 10 cases have been reported in the literature.
A 77-year-old female presented with a one-year history of lumbago and right-sided L3 dermatomal hypoesthesia. A dumbbell mass at the L2/3 vertebral level was identified on lumbar MRI. The lesion was irregularly shaped and isointense on T1W and hyperintense on T2W and DWI images with homogenous contrast enhancement. A presumptive diagnosis was schwannoma, but other malignant neoplasms were also considered because of its irregular shape, minimally dilated neural foramen and the involvement of the non-enhanced L3 nerve root. The patient underwent surgery with a lateral extracavitary approach. A histopathological examination revealed cavernous hemangioma.
Cavernous hemangioma should be included in the differential diagnosis of dumbbell-shaped spinal tumors when the intervertebral foramina is not highly dilated and non-enhanced nerve root is identified in the tumor.
大多数脊柱海绵状血管瘤发生于椎体，而单纯硬膜外海绵状血管瘤且无椎体受累情况较为罕见，仅占所有硬膜外脊柱肿瘤的4%。哑铃形脊柱海绵状血管瘤极为罕见，文献中仅报道过10例。
一名77岁女性，有一年腰痛病史及右侧L3皮节感觉减退。腰椎MRI显示L2/3椎体水平有一哑铃形肿块。病变形状不规则，T1加权像上等信号，T2加权像及扩散加权成像上高信号，增强扫描呈均匀强化。初步诊断为神经鞘瘤，但因其形状不规则、神经孔轻度扩张以及未强化的L3神经根受累，也考虑了其他恶性肿瘤。患者接受了经外侧腔外入路手术。组织病理学检查显示为海绵状血管瘤。
当椎间孔未高度扩张且肿瘤内发现未强化的神经根时，海绵状血管瘤应纳入哑铃形脊柱肿瘤的鉴别诊断。
