Golnari Pedram, Ansari Sameer A, Shaibani Ali, Hurley Michael C, Potts Matthew B, Kohler Missia E, Sugrue Patrick A, Jahromi Babak S
Department of Neurological Surgery and Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
Department of Neuropathology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
Surg Neurol Int. 2017 Jun 13;8:109. doi: 10.4103/sni.sni_103_17. eCollection 2017.
Spinal cavernous malformations usually affect the vertebral bodies and are seldom intradural. Here, we report a rare spinal intradural-extramedullary cavernous malformation associated with extensive superficial siderosis along the neuraxis in a patient with radicular complaints.
A 60-year-old male presented with subacute headaches, intermittent fever, and acute back and radicular leg pain for 1-2 weeks. Magnetic resonance imaging revealed an intradural-extramedullary lesion just below the conus medullaris (at the L2 level). There was associated subarachnoid hemorrhage in the lumbar cistern and superficial siderosis along the entire spinal neuraxis. Following surgical resection, the patient's symptoms resolved. Histopathology of the lesion was of a cavernous malformation.
There are only 56 cases of spinal intradural-extramedullary cavernous malformations published in the literature; however, only 3 described superficial neuraxis siderosis as noted in this case. In the present case, slowly recurring hemorrhages of the lesion located at the conus likely contributed to the complete neuraxis superficial siderosis. Timely evaluation and treatment of these lesions is warranted to avoid further compressive and/or hemorrhagic complications.
脊髓海绵状血管畸形通常累及椎体，很少位于硬膜内。在此，我们报告一例罕见的脊髓硬膜内-髓外海绵状血管畸形，该患者有神经根症状，同时沿神经轴出现广泛的浅表性含铁血黄素沉着症。
一名60岁男性，出现亚急性头痛、间歇性发热以及急性背痛和神经根性腿痛1 - 2周。磁共振成像显示在脊髓圆锥下方（L2水平）有一个硬膜内-髓外病变。腰池有蛛网膜下腔出血，且整个脊髓神经轴存在浅表性含铁血黄素沉着症。手术切除后，患者症状缓解。病变的组织病理学检查为海绵状血管畸形。
文献中仅发表了56例脊髓硬膜内-髓外海绵状血管畸形病例；然而，只有3例描述了如本病例中所见的神经轴浅表性含铁血黄素沉着症。在本病例中，位于脊髓圆锥的病变缓慢反复出血可能导致了整个神经轴的浅表性含铁血黄素沉着症。对这些病变进行及时评估和治疗，以避免进一步的压迫和/或出血并发症是必要的。
