Diagnosis and management of spinal epidural dumbbell-shaped cavernous vascular malformation

Abstract

Objective To investigate the patterns of clinical manifestations, diagnosis, treatment and surgical outcomes of spinal epidural dumbbell-shaped cavernous hemangiomas. Methods Between June 2008 and November 2013, a series of 9 patients with symptomatic spinal epidural dumbbell-shaped cavernous hemangiomas were surgically managed in Beijing Tiantan Hospital, in which the diagnoses were pathologically verified. The clinical manifestations, radiographic features, treatment modality and prognosis were retrospectively reviewed. The attention was specially paid to the differential diagnosis for other lesions that mimicking a dumbbell-shaped tumors. Results Among the 9 cases, 6 were male and 3 were female.The mean age at presentation was 58±12 years (range 34-79 years) The tumor locations included thoracic levels in 7 cases, cervical levels in 1 case and cervicothoracic junction in 1 case). Except two recurrent cases and one with acute onset, were the others demonstrated chronically progressive features. The initial diagnoses included schwannoma in 6 patients, cavernous hemangiomas in 1 case, meningioma in 1 case and angioma in 1 case.Complete resection was achieved in 7 patients, and partial resection was performed in the other 2 patients .The average volume of intraoperative blood loss measured 400±300 ml, ranging from 100 ml to 1 000 ml. None of the cases developed surgical complications. The follow-up lasted an average of 71±21 months (range 29-94 months), which demonstrated that significant improvement was achieved in 7 out of 9 cases, no significant symptom relief was reported in 1 case, and symptomatic worsening occurred in 1 case. one partially improved, and one worsened during follow-up. Conclusions The spinal epidural dumbbell-shaped cavernous hemangioma is relatively uncommon and thus easily misdiagnosed. Microsurgical operations seem to demonstrate relative safety and good outcomes. Key words: Spinal cord; Epidural space; Hemangioma, cavernous, central nervous system; Dumbbell-shaped; Disease attributes