T3 infantile hemangioma: first case of a tumor involving epidural, intradural extramedullary, and intradural intramedullary spaces.

Infantile hemangiomas (IHs) are the most common benign neoplasm of the neonatal and newborn period, affecting approximately 5% of infants. However, true IHs presenting in the neuraxis are quite rare with only 15 documented cases in the literature. Management of IH consists of utilizing steroids and immunomodulatory therapies to reduce the size of the tumor and surgery to remove the tumor to decrease symptoms and the risk of bleeding. Operative management of epidural and intradural extramedullary spinal hemangiomas has been described; however, management of intradural intramedullary IH has not been detailed in the literature. In this report, the authors describe the case of a 3-year-old girl who presented with multiple hemangiomas involving the liver, lung, and spine, with one component of the tumor involving the posterior intramedullary aspect of the spinal cord at the level of T3. After medical therapies had failed, the patient underwent endovascular embolization of the spinal hemangioma followed by resection of the tumor. While there is extensive literature on IH throughout many organ systems, only a handful of cases involving the neuraxis have been described. Operative management of refractory IH seems to allow for the reduction of tumor burden and the prevention of hemorrhagic injury.