title: Intradural extramedullary cavernoma of a lumbar nerve root mimicking neurofibroma. A report of a rare case and the differential diagnosis.
abstract: BACKGROUND
  Intradural extramedullary (IDEM) cavernomas are rare vascular malformations. They are well-circumscribed dark berry-like lesions with a histologic appearance of sinusoidal vascular channels. Neurofibromas are the most common IDEM tumors, originating from all nerve elements and leading to firm enlargement of the affected nerve root. These lesions are completely different; however, they may involve the spinal nerve roots or the major nerve trunks. Any similarities in clinical findings are based on different pathophysiology.
  
  
  OBJECTIVE
  To present a rare resemblance of an IDEM cavernoma to a neurofibroma.
  
  
  METHODS
  This is a case report with review of the literature focused on the differential diagnosis.
  
  
  METHODS
  A 79-year-old patient presented with acute sensorimotor disturbance from L2-S1 levels. The investigations showed an L2-L3 lesion occupying the canal. Findings resembled a neurofibroma and a surgical resection was decided.
  
  
  RESULTS
  The complete surgical resection revealed a vascular lesion originating from a nerve root. The histology confirmed an IDEM cavernoma. This is a unique case as such a clinical resemblance and a macroscopical appearance has not been reported for an IDEM cavernoma as yet. The patient showed full postoperative recovery from his initial symptoms.
  
  
  CONCLUSIONS
  Intradural extramedullary cavernoma is a rare cause of compression to spinal cord or nerve roots. Its manifestation characteristics are well defined and should always be part of the differential diagnosis. Intraoperative findings aid the diagnosis in nontypical cases before the final histology. The nontraumatic and nerve tissue sparing surgical resection warrants optimal postoperative results and excellent prognosis.
authors.affiliation: Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK. Electronic address: george.mataliotakis@gmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Mataliotakis
authors.affiliation: Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
authors.forename: Stravinsky
authors.initials: S
authors.lastname: Perera
authors.affiliation: Pathology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK.
authors.forename: Santhosh
authors.initials: S
authors.lastname: Nagaraju
authors.affiliation: Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Marchionni
authors.affiliation: Orthopaedic Spine Department, City General Hospital, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tzerakis
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018317:Nerve Sheath Neoplasms / Q000473:pathology* / Q000601:surgery; D009455:Neurofibroma / Q000175:diagnosis*; D013116:Spinal Cord / Q000473:pathology*; D013126:Spinal Nerve Roots / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Cavernoma; Intradural extramedullary cavernous angioma; Intraspinal tumours; Neurofibroma; Neurofibromatosis; Vascular malformations