Mid-Thoracic Epidural Cavernous Hemangioma Presenting as Subacute Paraparesis

Abstract

Introduction: Epidural cavernous hemangioma is a rare cause of spinal cord compression and is not often considered in the differential diagnosis of cord compressive lesions. Preoperative radiologic diagnosis is not straightforward and intraoperative appearance of the lesion during surgical decompression is often when the diagnosis is first suspected. We present a rare case of myelopathy secondary to cord compression due to an epidural cavernous hemangioma. Case Presentation: A 72-year-old woman presented with back pain and recurrent falls secondary to lower limb paraparesis and reduced sensation. Magnetic resonance imaging showed an extradural mass at T4 to T5 vertebral levels with extension into the right T4/T5 exit foramina. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiologic differential diagnosis included schwannoma and meningioma. The patient underwent urgent T4 to T6 laminectomy. Intraoperatively, the tumor was purely extradural and was dark purple in appearance. Total excision of the mass was possible because of preserved planes all around. Histopathology revealed cavernous hemangioma. Postoperatively, the patient’s back pain completely resolved with mild improvement in power in her lower limbs. Conclusions: We present a rare case of spinal cord compression due to an epidural cavernous hemangioma. Although rare, it should be considered in the differential diagnosis of spinal epidural cord compression. Expert and careful evaluation of magnetic resonance imaging may help to diagnose this lesion preoperatively and allow for adjunctive intervention such as radiotherapy or embolization, making subsequent surgical resection safer.