Extradural cavernous hemangioma of thoracic spine
Hemangioma cavernoso extradural da coluna torácica
Apio AntunesI; Mateus Felipe Lasta BeckII; Atahualpa Caue Paim StrapassonII; André Cerutti FranciscattoII; Mateus FranzoiII
IHead of Neurosurgical Unit, Associate Professor of Neurosurgery, FAMED, UFRGS
IIResident of Neurosurgery
Cavernous hemangioma of the central nervous system is a vascular malformation which is a developmental hamartoma, also known as cavernoma or cavernous malformation or venous angioma1.
Cavernomas may affect any segment of the neuraxis. Most of these malformations are intracranial: supratentorial compartment is a site usually affected2,3. Pure spinal epidural cavernomas represent approximately 12% of spinal cavernous anomalies4 and the thoracic segment is the most frequently affected5. There are approximately 80 cases of epidural cavernous hemangioma published in the literature4,5.
We report on a case of thoracic extradural cavernous hemangioma, with emphasis on the clinical aspects.
A 63-years-old female caucasian patient with a previous history of cryptogenic epilepsy was referred to our emergency department with complaints of a one year history of gait ataxia, numbness and dysesthesia in both lower limbs. In the last 2 months, she also noticed reduced strength in the lower limbs.
Neurological examination showed reduced strength in the lower limbs, grade 4/5 in the right lower limb and grade 3/5 in the left one. There was reduced sensation for all sensory modalities below the T10-11 dermatomes. There was also lower limb hyperreflexia and hypertonia, with bilateral extensor plantar response.
An MRI showed an epidural space-occupying lesion involving the T9-T10 spinal canal levels and extending to the T9 left foramen, with an intense and homogeneous contrast enhancement (Figure).
The patient was submitted to a T9-T10 laminectomy, including a T9 left foraminectomy. A posterior soft and reddish epidural mass with a good cleavage plan was completely removed. The patient evolved with partial improvement of sensibility in both lower limbs and strength.
Histological examination revealed thin-walled blood vessels lined with a single layer of endothelial cells, surrounded by connective tissue. The microscopic appearance was compatible with cavernous hemangioma.
Cavernoma is a benign tumor and it is considered a dysplasia of the vessels-forming mesoderm4. Cavernous hemangiomas in the vertebral, extradural, intradural extramedullary and intramedullary spaces are responsible for 3 to 16% of spinal vascular anomalies4,5.
Extradural cavernous hemangioma represent 4% of all spinal epidural lesions5. Modern diagnostic imaging techniques are increasing the number of diagnosis and its frequency may be more than previously reported in the medical literature5.
There are four clinical syndromes described: slow and progressive spinal cord syndrome, which is the most common form; acute spinal cord syndrome; back pain; and radiculopathy3.
Imaging diagnostic exams such as spine X-rays, myelography, CT and MRI are important for evaluating the relationship of the lesion with the surrounding anatomic structures1. Currently, MRI is the modality of choice5.
The treatment for these lesions is total removal of the tumor with microsurgical technique1.
Received 13 February 2011
Received in final form 31 November 2011
Accepted 7 April 2011
- 1. Hatiboglu MA, Iplikcioglu AC, Ozcan D. Epidural spinal cavernous hemangioma-case Report. Neurol Med Chir (Tokyo) 2006;46:455-458.
- 2. Goyal A, Singh AK, Gupta V, Tatke M. Spinal epidural cavernous haemangioma:a case report and review of literature. Spinal Cord 2002;40: 200-202.
- 3. Zevgaridis D, Buttner A, Weis S, Hamburger C, Reulen HJ. Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature. J Neurosurg 1988;88:903-908.
- 4. Saringer W, Nobauer I, Haberler C, Ungersbock K. Extraforaminal, thoracic, epidural cavernous hemangioma:case report with analysis of magnetic resonance imaging characteristics and review of the literature. Acta Neurochir (Wien) 2001;43:1293-1297.
- 5. Santoro A, Piccirilli M, Bristot R, Norcia V, Salvati M, Delfini R. Extradural spinal cavernous angiomas: report of seven cases. Neurosurg Rev 2005;28: 313-319.
Correspondence:Apio AntunesUnidade de Neurocirurgia / Serviço de Neurologia do HCPARua Ramiro Barcelos 2350 / 2º andar - 90035-903Porto Alegre RS - BrasilE-mail:
Publication in this collection
01 Sept 2011
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