Apostolakis Sotirios, Mitropoulos Athanasios, Diamantopoulou Kalliopi, Vlachos Konstantinos
Department of Neurosurgery, KAT General Hospital of Attica, Kifisia 145 61, Greece.
Department of Pathology, KAT General Hospital of Attica, Kifisia 145 61, Greece.
Surg Neurol Int. 2018 Aug 28;9:174. doi: 10.4103/sni.sni_212_18. eCollection 2018.
Cavernomas are benign malformations of the vasculature. In the central nervous system, they are mostly located supratentorially. However, in adults, cavernomas also comprise about 3% of all subdural spinal cord tumors. Notably, cavernomas of the cauda equina are extremely rare, with only 23 cases reported in the literature. Here, we report the 24 case involving a 77-year-old male.
A 77-year-old male presented with low back pain for 3 years duration. His history included prostate cancer, skin melanoma, and a sick sinus syndrome requiring a pacemaker. An enhanced computed tomography of the lumbar spine showed an inhomogeneously enhanced, intramedullary mass, located at the L3 level. The patient underwent an L3 hemilaminectomy with gross total excision of the lesion. Macroscopically, the tumor was mulberry-shaped and well demarcated. However, it was strongly adherent to a nerve root of the cauda equina which required resection. The histologic examination was consistent with a cavernoma. The patient subsequently fully recovered without a focal neurological deficit.
Cavernomas of the cauda equina are extramedullary, arise on the inner aspect of the dura, and may be tightly adhered to the nerve roots. To attain gross total excision, the involved nerve may have to be sacrificed; in some cases, this may result in a permanent neurological deficit. Of interest, half of the cauda equina lesions were previously found in patients who had prior radiotherapy; this was not the case in this patient.
海绵状血管瘤是血管的良性畸形。在中枢神经系统中，它们大多位于幕上。然而，在成年人中，海绵状血管瘤也约占所有硬脊膜下脊髓肿瘤的3%。值得注意的是，马尾神经海绵状血管瘤极为罕见，文献中仅报道了23例。在此，我们报告第24例病例，患者为一名77岁男性。
一名77岁男性因腰痛3年就诊。他有前列腺癌、皮肤黑色素瘤病史，且患有病态窦房结综合征需要起搏器治疗。腰椎增强计算机断层扫描显示L3水平有一个不均匀强化的髓内肿块。患者接受了L3半椎板切除术，病变被完整切除。肉眼观察，肿瘤呈桑葚状，边界清晰。然而，它与一条需要切除的马尾神经根紧密粘连。组织学检查结果符合海绵状血管瘤。患者随后完全康复，无局灶性神经功能缺损。
马尾神经海绵状血管瘤位于髓外，起源于硬脑膜内侧，可能与神经根紧密粘连。为实现完整切除，可能不得不牺牲受累神经；在某些情况下，这可能导致永久性神经功能缺损。有趣的是，半数马尾神经病变患者之前接受过放疗；该患者并非如此。
