Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature.
Epidural cavernous hemangiomas are increasingly identified as a cause of acute or chronic progressive spinal cord syndrome and local back pain or radiculopathy. The authors present three cases of spinal epidural cavernous hemangiomas manifesting as spinal cord syndrome, thoracic radiculopathy, and lumbar radiculopathy. Based on the imaging characteristics of these three cases and a review of the literature, the clinical signs and symptoms and their implications, the role of preoperative neuroradiological diagnosis, and the need for complete surgical resection are discussed. Epidural cavernous hemangiomas display consistent magnetic resonance imaging properties: T1-weighted images most commonly show a homogeneous signal intensity similar to those of spinal cord and muscle, and contrast enhancement is homogeneous or slightly heterogeneous. On T2-weighted images the signal of the lesion is consistently high and slightly less intense than that of cerebrospinal fluid. Frequently, the lesion is characterized by its extension through the intervertebral foramen. Awareness of these characteristics facilitates diagnosis and treatment of the lesions. Despite the risk of bleeding, in all three cases complete surgical excision was achieved.
Zevgaridis
D
D
Department of Neurosurgery and Institute of Neuropathology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Büttner
A
A
Weis
S
S
Hamburger
C
C
Reulen
H J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000175:diagnosis; D016063:Blood Loss, Surgical; D002555:Cerebrospinal Fluid; D003287:Contrast Media; D003937:Diagnosis, Differential; D004824:Epidural Space; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D009361:Neoplasm Invasiveness; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis; D012307:Risk Factors; D013116:Spinal Cord / Q000473:pathology; D013117:Spinal Cord Compression / Q000175:diagnosis; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000601:surgery; D013126:Spinal Nerve Roots / Q000473:pathology
D003287:Contrast Media