Department of Radiology, Sengkang General Hospital, Singapore, Singapore.
Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore.
Am J Case Rep. 2022 Jul 14;23:e936181. doi: 10.12659/AJCR.936181.
BACKGROUND Capillary hemangiomas are often seen on the skin of young individuals and are rarely found in the spine. These vascular lesions can arise from any spinal compartment, although they are more commonly found in the intradural extramedullary (IDEM) than the epidural location. We present a unique case of a woman with a histologically proven spinal epidural capillary hemangioma (SECH). The imaging and histopathological characteristics, as well as the treatment strategy of this vascular lesion, are highlighted along with a comprehensive review of the literature. CASE REPORT A 38-year-old woman presented with progressively worsening low back pain that radiated to both legs. Neurological examination revealed a weakness of the left leg without sensory loss. Magnetic resonance imaging (MRI) demonstrated an epidural tumor at L1-L2 level, making an obtuse angle with the cerebrospinal fluid (CSF) on sagittal T2-weighted images. The patient underwent a complete tumor resection without complications or recurrence. The histology revealed a capillary hemangioma. CONCLUSIONS SECH is exceedingly rare, with only 22 cases in the reported literature. Females are more commonly affected than males, and the thoracic spine is more commonly involved than the lumbar spine. SECH often mimics other epidural and IDEM lesions, leading to misdiagnosis. MRI is useful to differentiate SECH from lesions in the various spinal compartments; additionally, MRI is essential for preoperative planning and patient surveillance. Preoperative embolization is an option given the high vascularity of SECH. Surgery is the mainstay treatment, with a good prognosis, in most cases without recurrence.
毛细血管血管瘤常见于年轻人的皮肤，在脊柱中很少见。这些血管病变可发生于任何脊柱间隙，但在硬脊膜外（Epidural）比硬膜内髓外（Intradural extramedullary）更为常见。我们报告了一例经组织学证实的女性硬脊膜外毛细血管血管瘤（Spinal epidural capillary hemangioma，SECH）。本文强调了这种血管病变的影像学和组织病理学特征、治疗策略，并对文献进行了全面回顾。
一名 38 岁女性，逐渐出现严重的腰痛，放射至双腿。神经系统检查发现左腿无力，但无感觉丧失。磁共振成像（Magnetic resonance imaging，MRI）显示 L1-L2 水平硬膜外肿瘤，在矢状 T2 加权图像上与脑脊液（Cerebrospinal fluid，CSF）呈钝角。患者接受了完整的肿瘤切除术，无并发症或复发。组织学显示毛细血管血管瘤。
SECH 极为罕见，文献报道仅有 22 例。女性比男性更常见，胸椎比腰椎更常见。SECH 常与其他硬膜外和 IDEM 病变相混淆，导致误诊。MRI 有助于将 SECH 与不同脊柱间隙的病变相区别；此外，MRI 对于术前规划和患者监测至关重要。鉴于 SECH 的高血管性，术前栓塞是一种选择。手术是主要的治疗方法，大多数情况下预后良好，无复发。
