title: Pure spinal epidural cavernous hemangioma: A case series of seven cases.
abstract: BACKGROUND
  Pure spinal epidural cavernous hemangiomas (PSECHs) are rare vascular lesions with about 100 cases reported. Herein, we present a case series of 7 PSECHs discussing their clinical presentation, radiological characteristics, surgical technique and intraoperative findings, pathological features, and functional outcome.
  
  
  METHODS
  We retrieved from the retrolective databases of the senior authors, patients with pathologically confirmed PSECH operated between January 2002 and November 2015. From their medical records, the patients' sociodemographic, clinical, radiological, surgical, and histopathological data were retrieved and analyzed.
  
  
  RESULTS
  The mean age of the seven cases was 50.3 years. Four were females. All the five cases (71.4%) in the thoracic spine had myelopathy and the 2 (28.6%) lumbar cases had sciatica. Local pain was present in all the cases. All the lesions were isointense on T1-weighted images, hyperintense on T2-weighted images, and in five cases there was strong homogeneous enhancement. In six cases (85.7%), classical laminectomy was done; lesions resected in one piece in five cases. Total excision was achieved in all the cases. Lesions were thin-walled dilated blood vessels, lined with endothelium, and engorged with blood and with scanty loose fibrous stroma. The median follow-up was 12 months (range: 1-144 months). All patients gradually improved neurologically and achieved a good outcome with no recurrence at the last follow-up.
  
  
  CONCLUSIONS
  PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.
authors.affiliation: Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
authors.forename: Ignatius Ngene
authors.initials: IN
authors.lastname: Esene
authors.affiliation: Department of Neurosurgery, Ain Shams University, Cairo, Egypt; Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Ashour
authors.affiliation: Department of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Marvin
authors.affiliation: Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nosseir
authors.affiliation: Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
authors.forename: Zeiad Y
authors.initials: ZY
authors.lastname: Fayed
authors.affiliation: Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: Seoud
authors.affiliation: Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: El Bahy
keywords: Cavernous hemangioma; epidural; functional outcome; pathology; spine; surgical findings