Cavernous angiomas of the cauda equina: case report and review of the literature

Abstract

Background Cavernous hemangiomas of the spine and spinal cord are relatively uncommon lesions that are being discovered more frequently because of the increased use of magnetic resonance imaging (MRI). We present a rare case of a symptomatic cavernous hemangioma of the cauda equina. Case Description A 49-year-old woman presented to our institution with the chief complaint of low back pain of acute onset. On physical examination the patient was found to be tender to percussion over the lumbar spine, had tenderness over the sciatic nerve, loss of pinprick sensation over the right lateral foot and loss of the Achilles’ reflex on the right. In addition, she was found to have a large postvoid urinary bladder residual volume. MRI revealed a 20 mm × 11 mm nonenhancing, heterogenous mass obliterating the spinal canal at the L4 level. At operation, this lesion was found to be adherent to the nerve roots and was completely resected. Pathology revealed this lesion to be a cavernous angioma of the cauda equina. A review of the pertinent literature is presented. Conclusions Cavernous hemangiomas of the cauda equina are extremely rare lesions that may present as low back pain, neurologic deficit, or as subarachnoid hemorrhage. They can be successfully treated with surgical excision.