Spinal Epidural Cavernous Hemangioma of the Thoracic Spine: A Case Report

Abstract

Cavernous hemangiomas can arise in any region of the body, including the central nervous system. Spinal cavernous hemangiomas account for 5% - 12% of all cases of vertebral vascular malformation. Most of these are of vertebral origin, and cases that are non-vertebral in origin are rare. We encountered a patient with a relatively rare spinal epidural cavernous hemangioma of the thoracic spine that was non-vertebral in origin. The patient was a 63-year-old man. He had become aware of bilateral leg pain and numbness about 2 months earlier, and gait disturbance appeared gradually thereafter. On MRI, a lesion showing iso-intensity on T1-weighted imaging and high intensity on T2-weighted imaging was detected at the 7th thoracic vertebra. On gadolinium contrast-imaging, the lesion was found to be a homogenously-enhanced dumbbell-shaped extradural spinal neoplasm protruding from the left 7th/8th thoracic intervertebral foramen. A neurogenic tumor was suspected based on myelography and MRI findings, and complete tumorectomy was performed, which improved the lower limb symptoms and gait disturbance. The histopathological diagnosis was cavernous hemangioma. Epidural hemangiomas arise from the vertebra in many cases, and pure spinal epidural cavernous hemangiomas are rare. It is difficult to make a preoperative diagnosis because there are no specific imaging findings that can differentiate these tumors. It may be important to consider this disease before surgery in the differential diagnosis of epidural tumors.