Spinal epidural vascular tumors and malformations

Abstract

Dear Editor, We read the article “Pure spinal epidural cavernous hemangioma” by Zhong et al. [4] published recently in Acta Neurochirurgica with great interest and found that some discussion is pertinent. In 1982, Mulliken and Gloweki [3] classified vascular anomalies into two categories of hemangiomas (infantile hemangioma, congenital hemangioma, kaposiform hemangioendothelioma, and tufted angioma) and vascular malformation (arteriovenous, venous, lymphatic, and capillary malformations). In 1996, the International Society for the Study of Vascular Anomalies approved this classification system to establish a common language for the many different medical specialists who are involved in the management of these lesions. Previously, there was no precise classification and naming of hemangioma and vascular malformation. They were mostly referred to as hemangioma or lymphangioma together, and were primarily named according to the lesion’s morphology. For example, hemangioma included capillary hemangioma, cavernous hemangioma, racemose hemangioma; lymphangioma included capillary, cavernous and cystic. Since patients with hemangioma or vascular malformations can be treated in different clinical departments, even the same lesion can also get different names, as wine-color stains are referred as PWS in some departments. In 1982, Mulliken and Gloweki put forward that there should be a re-classification according to the cell biological and pathological characteristics, and made it clear that the two types of lesions as tumor and deformity should be distinguished. They were divided into two categories of hemangiomas and vascular malformations according to whether the proliferations of endothelial cells were found in the pathologic tissues. Hemangioma was the embryonic vascular endothelial cell proliferation characterized by benign tumor. This is quite different from the original traditional classification that was based on morphology and pathology. The occurance of hemangioma in neonates is about 3 %, which often occurs in the neonatal period and then enters the proliferative phase. Generally, it should get timely treatment once it is found. Ninety percent of vascular malformations are there at birth, but with no proliferation phase, they will grow proportionally with the increase in age [1]. Previous traditional classification rules defined wine-color stains, cavernous hemangioma, and racemose hemangioma as all belonging to vascular malformation, but they are now named as capillary malformations, venous malformation and arteriovenous malformations respectively. Due to errors in classification, many vascular malformations are mistaken as hemangioma, and many patients received false and ineffective treatment. The term “cavernous hemangioma” refers to a venous malformation. It consists of dilated sinusoidal channels lined by quiescent endothelium. The magnetic resonance imaging features of vascular malformations include: T2-weighted images that performed as high-intensity signal, T1-weighted images performed as the iso-intensity signal, just as that recorded in the article; magnetic resonance imaging can reveal the spinal epidural venous malformation, intra-lesion hemorrhage and thrombosis. Magnetic resonance imaging can demonstrate the breadth of lesions and the relationship between lesions and adjacent tissues; it can also help to provide the potential treatment plans. M. Zhu :Y. Luo : L. Qiu (*) Department of Diagnostic Ultrasound, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan, China e-mail: vigour_sky@163.com