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Pure extraosseous spinal epidural cavernous hemangioma presenting with acute paraplegia: a case report

Abstract

Introduction

Spinal hemangiomas are benign vascular tumors that most commonly originate from the osseous structures of the spinal column. Epidural spinal hemangiomas without osseous involvement are uncommon and are classified as pure epidural spinal hemangiomas. Extraosseous spinal epidural cavernous hemangiomas are rarely described and among available reports; most patients present with slowly progressive neurological symptoms. Herein, we present a novel case of acute neurological dysfunction from a pure spinal epidural hemangioma that was managed through surgical resection with good neurological recovery at follow-up.

Case presentation

A 45-year-old previously healthy man presented to the emergency room with sudden inability to ambulate and was found to have bilateral lower extremity weakness. Magnetic resonance imaging of the spine demonstrated an epidural mass extending out of the right T5/6 neural foramen. The mass enhanced heterogeneously, and the preoperative diagnosis favored an atypical schwannoma. The lesion was surgically removed en-bloc through a midline posterior decompression with instrumentation. Histopathologic examination confirmed cavernous hemangioma pathology. Within 6 weeks of the surgical intervention, the patient had regained full sensorimotor function and these effects were durable through long term follow-up.

Discussion

Pure spinal epidural hemangiomas are rare and generally have an insidious clinical course. This case report highlights that these uncommon lesions may present with substantial and acute neurological dysfunction requiring urgent neurosurgical intervention. This should prompt clinicians to consider cavernous hemangioma in the differential diagnosis of patients presenting with acute neurological deterioration and an epidural spinal tumor.

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Fig. 1: Preoperative and postoperative imaging depicting the mid-thoracic spinal mass lesion.
Fig. 2: Intraoperative images.
Fig. 3: Key histopathological slides depicting cavernous hemangioma.

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Contributions

KE contributed to the literature review and manuscript preparation. ARM contributed to the literature review and manuscript preparation and editing. AKM contributed to the literature review and manuscript preparation and editing. EMH contributed to manuscript preparation and editing. DGM prepared the microscopic slide images and contributed to manuscript editing. YN contributed to the literature review and manuscript editing. JRW contributed to manuscript editing. CDW contributed to manuscript preparation and editing.

Corresponding author

Correspondence to Christopher D. Witiw.

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The authors declare no competing interests.

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Eguchi, K., Malhotra, A.R., Malhotra, A.K. et al. Pure extraosseous spinal epidural cavernous hemangioma presenting with acute paraplegia: a case report. Spinal Cord Ser Cases 8, 63 (2022). https://doi.org/10.1038/s41394-022-00531-9

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