Epidural Spinal Cavernous Hemangioma

Abstract

Five cases of epidural spinal cavernous hemangioma submitted to magnetic resonance imaging and surgery were reviewed. To correlate different magnetic resonance imaging appearances of epidural spinal cavernous hemangioma with histologic findings. Cavernous hemangioma is an uncommon vascular malformation that may occur anywhere in the central nervous system. Purely epidural lesions are very rare. Accurate correlation between magnetic resonance imaging appearances and histologic findings have not been reported in the literature. Five cases of epidural spinal cavernous hemangioma that had undergone magnetic resonance imaging evaluation followed by microsurgical removal, were retrospectively reviewed. Conventional spin-echo T1-, proton density- and T2-weighted magnetic resonance images were obtained in all cases, and gadolinium was used in all but one. Two cases have also been evaluated with computed tomography. In two cases, magnetic resonance imaging showed mixed low- and high-signal intensity components in all sequences and pathologic examination showed degenerative phenomena and hemosiderin pigments. In the remaining three cases, magnetic resonance imaging showed low- or intermediate-signal intensity on T1-weighted and high-signal intensity on proton density- and T2-weighted images. In those cases, pathologic examination showed an absence of degenerative phenomena and no signs of hemorrhage. All patients underwent surgery by laminectomy and microsurgical resection. In all, significant improvement was obtained. Epidural spinal cavernous hemangioma has a different magnetic resonance imaging appearance probably because of the presence or absence of the degenerative phenomena and hemosiderin pigments. As in cerebral locations, mixed signal intensity in all sequences on magnetic resonance images might be indicative of cavernous hemangioma. Presumptive preoperative diagnosis of the lesion may render the surgical approach less invasive.