Johnson W Chase, Espinosa Jonathan, Tavakoli Samon, Fischer Victoria, Gragnaniello Cristian, Mesfin Fassil, Mathis Derek, Hobbs Joseph, McGinity Michael
Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, TX, USA.
Department of Pathology, Methodist Hospital Stone Oak, San Antonio, TX, USA.
J Spine Surg. 2024 Mar 20;10(1):152-158. doi: 10.21037/jss-23-113. Epub 2024 Mar 14.
Intradural, extramedullary capillary hemangiomas of the cauda equina are exceedingly rare malformations arising from the endothelial cells of the nervous system vasculature. Roughly 20 cases have been reported in the literature, with the youngest and only pediatric case being in a 17-year-old patient. We report the youngest case of intradural extramedullary capillary hemangioma of the cauda equina in a 14-year-old patient.
A 14-year-old female presented with two-month history of low back pain with bilateral leg pain and numbness. Magnetic resonance imaging (MRI) revealed an L2 well-defined homogenous contrast-enhancing intradural, extramedullary mass causing severe spinal canal stenosis. Patient underwent laminoplasty for resection of an intradural tumor. Intraoperative hemostasis was readily achieved via early identification and coagulation of the predominate feeding vessel. Postoperatively, the patient awoke with no deficits and resolved leg pain. A 3-month postoperative MRI revealed no tumor recurrence and fully healed lamina.
Given the benign nature, the operative goal is complete excision of the tumor without damage to surrounding neural structures. Postoperatively the goal is relief of pain and improvement in neurologic function. To our knowledge we report the first case in which laminoplasty is utilized for the treatment of this pathology in a pediatric patient. Evidence for laminoplasty in this patient population is sparse and future studies are still needed. In any case, reconstruction of the surgical site in a manner that returns the patient's normal anatomy should be strongly considered especially in younger patients.
马尾神经硬膜内、髓外毛细血管瘤是一种极为罕见的由神经系统脉管系统内皮细胞形成的畸形病变。文献中报道了约20例，最年轻且唯一的儿科病例是一名17岁患者。我们报告了一名14岁患者的马尾神经硬膜内髓外毛细血管瘤的最年轻病例。
一名14岁女性，有两个月的下背部疼痛伴双侧腿痛和麻木病史。磁共振成像（MRI）显示L2水平有一个边界清晰的均匀强化硬膜内、髓外肿块，导致严重的椎管狭窄。患者接受了椎板成形术以切除硬膜内肿瘤。术中通过早期识别并凝固主要供血血管，很容易实现止血。术后，患者苏醒时无神经功能缺损，腿痛缓解。术后3个月的MRI显示无肿瘤复发，椎板完全愈合。
鉴于其良性性质，手术目标是完整切除肿瘤而不损伤周围神经结构。术后目标是缓解疼痛并改善神经功能。据我们所知，我们报告了首例在儿科患者中使用椎板成形术治疗这种疾病的病例。该患者群体中椎板成形术的证据稀少，仍需要进一步研究。无论如何，尤其对于年轻患者，应强烈考虑以恢复患者正常解剖结构的方式重建手术部位。
