title: Primary spinal epidural cavernous hemangioma: clinical features and surgical outcome in 14 cases.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical characteristics, imaging features, differential diagnosis, treatment options, and prognosis for primary spinal epidural cavernous hemangiomas.
  
  
  METHODS
  Fourteen patients with pathologically diagnosed non-vertebral origin cavernous hemangiomas who had undergone surgery at Beijing Tiantan Hospital between 2003 and 2012 were identified in the hospital's database. The patients' clinical data, imaging characteristics, surgical treatment, and postoperative follow-up were analyzed retrospectively.
  
  
  RESULTS
  There were 9 males and 5 females with an average age of 51.64 years. The primary epidural cavernous hemangiomas were located in the cervical spine (2 cases), cervicothoracic junction (2 cases), thoracic spine (8 cases), thoracolumbar junction (1 case), and lumbar spine (1 case). Hemorrhage was confirmed in 4 cases during surgery. Preoperatively 5 lesions were misdiagnosed as schwannoma, 1 was misdiagnosed as a meningioma, and 1 was misdiagnosed as an arachnoid cyst. Preoperative hemorrhages were identified in 2 cases. Three patients had recurrent cavernous hemangiomas. The initial presenting symptoms were local pain in 5 cases, radiculopathy in 6 cases, and myelopathy in 3 cases. Upon admission, 1 patient had radicular symptoms and 13 had myelopathic symptoms. The average symptom duration was 18 months. All patients underwent surgery; complete resection was achieved in 8 cases, subtotal resection in 4 cases, and partial resection in 2 cases. Postoperative follow-up was completed in 10 cases (average follow-up 34 months); 1 patient died, 5 patients showed clinical improvement, and 4 patients remained neurologically unchanged.
  
  
  CONCLUSIONS
  Total surgical removal of spine epidural cavernous hemangiomas with a chronic course is the optimum treatment and carries a good prognosis. Secondary surgery for recurrent epidural cavernous hemangioma is technically more challenging. In patients with profound myelopathy from acute hemorrhage, even prompt surgical decompression can rarely reverse all symptoms.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University;
authors.forename: Teng-Yu
authors.initials: TY
authors.lastname: Li
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Xu
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: James
authors.initials: J
authors.lastname: Wang
authors.forename: Gui-Huai
authors.initials: GH
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016080:Arachnoid Cysts / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D015174:Epidural Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: DSA = digital subtraction angiography; cavernous hemangiomas; imaging features; prognosis; spinal epidural lesions; surgical treatment; vascular disorders