Department of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Department of Neurosurgery, Nagoya University, Nagoya, Japan.
Spinal Cord Ser Cases. 2022 Jun 30;8(1):63. doi: 10.1038/s41394-022-00531-9.
Spinal hemangiomas are benign vascular tumors that most commonly originate from the osseous structures of the spinal column. Epidural spinal hemangiomas without osseous involvement are uncommon and are classified as pure epidural spinal hemangiomas. Extraosseous spinal epidural cavernous hemangiomas are rarely described and among available reports; most patients present with slowly progressive neurological symptoms. Herein, we present a novel case of acute neurological dysfunction from a pure spinal epidural hemangioma that was managed through surgical resection with good neurological recovery at follow-up.
A 45-year-old previously healthy man presented to the emergency room with sudden inability to ambulate and was found to have bilateral lower extremity weakness. Magnetic resonance imaging of the spine demonstrated an epidural mass extending out of the right T5/6 neural foramen. The mass enhanced heterogeneously, and the preoperative diagnosis favored an atypical schwannoma. The lesion was surgically removed en-bloc through a midline posterior decompression with instrumentation. Histopathologic examination confirmed cavernous hemangioma pathology. Within 6 weeks of the surgical intervention, the patient had regained full sensorimotor function and these effects were durable through long term follow-up.
Pure spinal epidural hemangiomas are rare and generally have an insidious clinical course. This case report highlights that these uncommon lesions may present with substantial and acute neurological dysfunction requiring urgent neurosurgical intervention. This should prompt clinicians to consider cavernous hemangioma in the differential diagnosis of patients presenting with acute neurological deterioration and an epidural spinal tumor.
脊髓血管瘤是一种良性血管肿瘤，最常见于脊柱的骨结构起源。无骨累及的硬膜外脊髓血管瘤较为少见，被归类为单纯硬膜外脊髓血管瘤。骨外硬膜外海绵状血管瘤很少被描述，在现有的报告中；大多数患者表现为进展缓慢的神经症状。在此，我们报告了一例新的单纯性脊髓硬膜外血管瘤引起的急性神经功能障碍病例，该病例通过手术切除得到了很好的神经恢复。
一名 45 岁的既往健康男性因突然无法行走而到急诊室就诊，被发现双侧下肢无力。脊柱磁共振成像显示硬膜外肿块从右侧 T5/6 神经孔延伸出来。肿块不均匀增强，术前诊断倾向于非典型神经鞘瘤。病变通过中线后路减压和器械固定整块切除。组织病理学检查证实为海绵状血管瘤病变。在手术干预后的 6 周内，患者恢复了全部感觉运动功能，这些效果在长期随访中是持久的。
单纯性脊髓硬膜外血管瘤罕见，通常具有隐匿性的临床病程。本病例报告强调，这些罕见病变可能表现出显著的急性神经功能障碍，需要紧急神经外科干预。这应该促使临床医生在出现急性神经恶化和硬膜外脊髓肿瘤的患者中考虑海绵状血管瘤作为鉴别诊断。
