Epidural Capillary Hemangioma Research Articles

DUMBBELL-SHAPED EPIDURAL CAPILLARY HEMANGIOMA, CASE REPORT AND REVIEW OF THE LITERATURE

: Hemangiomas are benign vascular hamartomas. Spinal epidural capillary hemangiomas(SECH) are rare and dumbbell-shaped SECH are even extremely rare. The complete surgical excision isthe treatment of choice, yet this represents a dilemma as the mass is usually discovered late in big size.

Lumbar Spinal Epidural Capillary Hemangioma: A Case Report and Literature Review

Patient: Female, 38-year-old Final Diagnosis: Spinal capillary hemangioma Symptoms: Leg cramp • low back pain • paresthesia • unsteady gait Medication: — Clinical Procedure: Surgical resection Specialty: Radiology Objective: Rare disease Background:Capillary hemangiomas are often seen on the skin of young individuals and are rarely found in the spine. These vascular lesions can arise from any spinal compartment, although they are more commonly found in the intradural extramedullary (IDEM) than the epidural location. We present a unique case of a woman with a histologically proven spinal epidural capillary hemangioma (SECH). The imaging and histopathological characteristics, as well as the treatment strategy of this vascular lesion, are highlighted along with a comprehensive review of the literature.Case Report:A 38-year-old woman presented with progressively worsening low back pain that radiated to both legs. Neurological examination revealed a weakness of the left leg without sensory loss. Magnetic resonance imaging (MRI) demonstrated an epidural tumor at L1–L2 level, making an obtuse angle with the cerebrospinal fluid (CSF) on sagittal T2-weighted images. The patient underwent a complete tumor resection without complications or recurrence. The histology revealed a capillary hemangioma.Conclusions:SECH is exceedingly rare, with only 22 cases in the reported literature. Females are more commonly affected than males, and the thoracic spine is more commonly involved than the lumbar spine. SECH often mimics other epidural and IDEM lesions, leading to misdiagnosis. MRI is useful to differentiate SECH from lesions in the various spinal compartments; additionally, MRI is essential for preoperative planning and patient surveillance. Preoperative embolization is an option given the high vascularity of SECH. Surgery is the mainstay treatment, with a good prognosis, in most cases without recurrence.

Spinal epidural capillary hemangioma: A systematic literature review and an illustrative case

BackgroundSpinal hemangiomas are rare vascular malformations resulting from proliferation of vascular endothelial cells. The cavernous form is the most common and represents 5-12% of spinal vascular malformations, while the capillary form is rare. Case DescriptionA 56-year-old patient with no past medical history presented with progressive spinal cord compression symptoms localizing to the T10 level with MRC grade 4 proximal paraparesis. Preoperative MRI demonstrated a well-delineated, dumbbell-shaped, epidural lesion, without bony involvement, resulting in spinal cord compression at the T7 and T8 levels. The patient underwent gross total surgical resection of the lesion. At the one month follow up, the patient's strength improved to MRC grade 5, and sensation had fully returned. The histopathological diagnosis was a capillary hemangioma. Exclusively epidural capillary hemangiomas are extremely rare with only 26 cases reported in the literature. They are mainly located at the thoracic level (T4-T6). The MRI features include a well-circumscribed mass, hyperintense on T2-weighted sequence in 92% of cases, isointense on T1-weighted sequence in 88% of cases, and homogeneous contrast enhancement in 100% of cases. No tumor recurrence has been observed after gross total surgical removal. ConclusionsWhen evaluating progressive spinal cord compression by a purely epidural spinal lesion, the differential diagnosis should include capillary hemangioma, in addition to schwannoma, meningioma, and lymphoma. Early and complete surgical removal is the first line treatment.

Rapid growth of spinal epidural capillary hemangioma associated with isolated intraosseous lesion at the same level: A case report

A 47-year-old man presented with a spinal epidural capillary hemangioma manifesting as a 6-month history of worsening low back pain and lower limb pain. Computed tomography and magnetic resonance imaging (MRI) at a previous hospital showed intraosseous abnormal signals and an epidural lesion at the L3 level. One month later, MRI revealed rapid growth of the epidural lesion. Total resection of the epidural tumor and partial removal of the intraosseous tumor were performed. Macroscopically, the intraosseous lesion and epidural lesion seemed to be isolated from each other. Histopathological diagnosis was consistent with capillary hemangioma. Spinal epidural capillary hemangioma sometimes recurs via underlying arteriovenous anastomosis. Progressive clinical symptoms, as seen in our case, indicate the possibility of tumor growth even if the lesions are well demarcated, which suggests of benign tumor. Spinal epidural capillary hemangioma in addition to metastatic spinal tumors should be considered in the differential diagnosis of spinal epidural tumors associated with intraosseous lesions.

Impetuous expansion of pure epidural capillary hemangioma in pregnancy: A rare cause of acute paraplegia

Abstract Background Purely epidural spinal hemangioma (PESH) represents a rare clinical entity. The majority of such reports focuses on the cavernous variety and the capillary type remains extremely rare. A minority of these lesions may cause acute clinical presentations, mostly from hemorrhage or less commonly due to tumor expansion. Acute paraplegia in pregnancy from PESH is extremely rare and may pose management dilemma. Case report A 25-year old pregnant lady, 34 weeks into her pregnancy, presented with one-week history of paraplegia with bladder bowel involvement. On MRI, a dorsal epidural contrast enhancing mass with transforaminal extension was noted at D10–11 level. An emergency caesarean section (CS) to deliver the baby was followed by tumor excision after 48 h. The patient gradually recovered and regained 3/5 power in her lower limbs at 6 months follow up. Conclusion PESH of capillary variety is a rare cause of acute paraplegia in pregnancy. Preoperative suspicion of this diagnosis is extremely unlikely and regardless of the timing of surgery, such acute paraplegias rarely improve completely. Fetal lung maturity is an important factor determining the surgical priority.

A case of thoracic dumbbell-shaped epidural capillary hemangioma

A case of thoracic dumbbell-shaped epidural capillary hemangioma

A Rare Case of Dumbbell-shaped Spinal Epidural Capillary Hemangioma

A Rare Case of Dumbbell-shaped Spinal Epidural Capillary Hemangioma

Epidural Capillary Hemangioma of the Thoracic Spine

Dear Editor, I read with great interest the paper by Figueiredo et al describing a case of epidural capillary hemangioma of the thoracic spine.1 They are, indeed, very rare tumors and reported as case reports, as mentioned in the represented manuscript. Most of the hemangiomas seen at the location are the cavernous type. Capillary-cavernous, arteriovenous, or venous hemangiomas with pure spinal epidural location are uncommon vascular tumors in contrast to those in the other sites of spinal column. We reported the first MRI study of a case of epidural mixed type capillary-cavernous hemangioma of the thoracic spine with foraminal extension presenting during the third trimester of pregnancy in 2007. In MR examination, the sign of spinal epidural hemangiomas is generally homogeneous and similar to that of spinal cord because of the slow blood flow on T1-weighted images. These tumors have high signal intensity on T2-weighted images because of the high content of stagnant blood. The tumor was reported as mixed type because in histopathological examination, the specimen was showing a tumor composed of dilated and rather thin-walled cavernous component and numerous small capillaries of the capillary component adjacent to each other. As it was stressed by the authors, epidural capillary hemangiomas should be included in the differential diagnosis of spinal epidural lesions, and surgical excision is recommended.

Hémangiome capillaire épidural lombosacré mimant un neurinome en sablier : à propos d’un cas et revue de la littérature

IntroductionCapillary hemangiomas are benign endothelial cell neoplasms that are believed to be hamartomatous proliferations of vascular endothelial cells. The occurrence of spinal epidural capillary hemangiomas is exceedingly rare. Only 8 epidurally located cases of capillary hemangiomas in the spinal canal have been reported in the literature. Case reportWe report for the first time, to our knowledge, a case of lumbosacral epidural capillary hemangioma revealed by S1 back pain and radicular pain in a 60-year-old patient, caused by an L5-S1 epidural capillary hemangioma. The neurological symptoms of the patient improved after surgery. ConclusionSpinal epidural capillary hemangioma is exceedingly rare. These lesions are benign and can mimic dumbbell-shaped neurinoma. Total removal by surgery is curative.

Epidural Capillary Hemangioma of the Thoracic Spine

Background Hemangiomas are congenital vascular malformations pathologically considered as harmatomas and classified as capillary, cavernous, arteriovenous or venous, and usually located at soft tissue or bone, mainly in the spinal column. Pure epidural capillary hemangiomas are extremely rare lesions that should be included in the differential diagnosis of spinal epidural lesions; only three patients with epidural capillary hemangiomas have been reported to date. Case Report We report a case of a 57-year-old man that complained of dorsal and back pain. The neurological examination revealed back tenderness and crural paraparesis. His reflexes were exaggerated and Babinski sign was present on both sides. A magnetic resonance imaging showed an epidural lesion at the level of T10–12 that demonstrated extension with intense postgadolinium enhancement. These lesions were different from more common lesions, mainly schwanommas, mainly due to the foraminal extension, which sets them apart from cavernous hemangiomas. The surgical ressection was performed. After laminectomy, a reddish epidural mass that extended into the right T11–12 foramina was revealed. The feeding vessels had to be identified and divided. In such cases, the surgeon must carefully dissect the lesion circumferentially away from the dura and employ judicious hemostasis. The patients histopathological examination revealed a vascular tumor composed of vessels of several calibers. The imagery obtained from the exams led to the diagnosis of a capillary hemangioma. Conclusions Pure epidural capillary hemangiomas should be included in the differential diagnosis of spinal epidural lesions, mainly schwanommas, especially due to the foraminal extension, which may differentiates them from cavernous hemangiomas. Surgical excision is mandatory and intervertebral foraminal extension may preclude gross total resection.

Epidural capillary hemangioma of the thoracic spine with proximal nerve root involvement and extraforaminal extension

Dear Editor, The occurrence of purely epidural capillary hemangioma is exceedingly rare, with only four reported cases in the English literature [3, 6, 7, 12]. Because of the excessive vascularity of capillary hemangioma, en bloc removal and/ or preoperative embolization of feeding arteries of the lesion should be recommended [8]. However, as consensus magnetic resonance imaging (MRI) study and specific features regarding capillary hemangiomas are not yet available, they are usually misdiagnosed preoperatively [3, 7]. Here, we report a case of a capillary hemangioma of the thoracic epidural region, with particular emphasis on relevant radiological features that could aid in the differential diagnosis of the lesion and therefore allow appropriate management. A 59-year-old woman presented with a 1-year history of back pain and right intercostal neuralgia. Physical examination revealed proprioceptive ataxia that caused difficulties with walking, decrease of the motor strength in lower limbs, and brisk osteotendinous reflexes. MRI (Fig. 1a–d) demonstrated a well-circumscribed, probably epidural, avidly enhancing mass that extended from T5 to T7, with intrathoracic extension through the right foramen at T6–T7, abutting the adjacent pleura. Signal void areas in and around the lesion indicated the presence of draining veins, suggesting the differential diagnosis of vascular pathologies such as hemangioma or hemangioblastoma. A T5–T7 laminectomy was performed with removal of the right T6–T7 facet joint and corresponding costotransverse joint to expose the whole lesion. The spongy, redpurple hemorrhagic epidural mass (Fig. 1e) was clearly originating from the T6 proximal nerve root, easily cleaved from the dura, and excised en bloc (Fig. 1f) as planned preoperatively. Many small feeder branches and vessels draining into the epidural venous system were sacrificed. The estimated intraoperative blood loss was 2 l. Pathologic examination showed innumerable thin-walled capillary vessels, lined by flattened endothelium and embedded within a loose connective tissue stroma (Fig. 1g) consistent with a capillary hemangioma. Unlike cavernous hemangiomas, the lesion was devoid of abnormally hyalinized vascular channels, thromboses, calcifications, or surrounding deposition of hemosiderin pigment. Capillary hemangiomas are considered hamartomatous proliferations of vascular endothelial cells [2]. They are classified by the predominant type of vascular channel (capillary, cavernous, arteriovenous, or venous) observed at histological examination. Epidural hemangiomas are actually considered to be an extension of vertebral lesions [4, 5]. The occurrence of purely spinal epidural hemangiomas is exceedingly rare, and most of the reported cases were a cavernous type [4, 5, 9]. However, as histological differentiation between capillary hemangioma and cavernous hemangioma is not always unequivocal, some epidural capillary hemangiomas may have been published under the designation of cavernous F. Vassal : C. Nuti Department of Neurosurgery, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France

Lumbar Epidural Capillary Hemangioma Presenting as Lumbar Disc Herniation Disease

A case of lumbar spinal epidural hemangioma is presented. To present the first reported lumbar spinal epidural hemangioma patient clinically mimicking the lumbar disc herniation disease. Capillary hemangiomas are benign endothelial cell neoplasms that are believed to be hamartomatous proliferations of vascular endothelial cells. The occurrence of spinal epidural capillary hemangiomas is exceedingly rare. There are only 3 reported epidurally located cases of capillary hemangiomas in the spinal channel in literature. Lumbar spinal epidural capillary hemangioma in a patient has not been previously reported. Radiologic features, pathology, and clinical course were documented. L4 hypoesthesia and back pain of the patient was caused by an epidurally located capillary hemangioma. The neurologic symptoms of the patient were markedly improved after surgery. We have reported for the first lumbar epidural capillary hemangioma patient in literature. These lesions are benign and surgical treatment is curative.

Proximal nerve root capillary hemangioma presenting as a lung mass with bandlike chest pain: case report and review of literature

Background Capillary hemangiomas occasionally occur in the peripheral nervous system (PNS), presenting as mass lesions causing proximal nerve root symptoms, thus prompting neurosurgical intervention. In contrast to cavernous angiomas, which may also occasionally involve the PNS, capillary hemangiomas have little or no tendency for acute or chronic bleeding and, hence, lack the apoplectic symptomatic onset and neuroimaging features of hemosiderin deposition as seen in cavernous angiomas. Case Description A 56-year-old man presented with chronic, radiating, bandlike, chest wall pain. Chest radiograph revealed an apical lung mass suspicious for malignancy. Subsequent magnetic resonance imaging revealed an enhancing dumbbell-shaped mass extending into the spinal canal and chest cavity at T3, causing a slight degree of lung compression. Differential diagnostic considerations included schwannoma, neurofibroma, and meningioma. At operation, the spongy, reddish purple vascular tumor was easily separated from dura but had to be excised en bloc, with the T3 nerve root at the neural foramen. The large intrathoracic portion measuring 37 × 41 mm was left behind. Pathology was consistent with a capillary hemangioma. Conclusions We present the second case in the English language literature of a dumbbell-shaped, epidural capillary hemangioma with intrathoracic extension. We review the literature on proximal nerve capillary hemangiomas and contrast these with cavernous angiomas and capillary hemangioblastomas, both of which occasionally involve proximal nerves. Unlike capillary hemangioblastomas, which may be multiple and associated with von Hippel–Lindau (VHL) syndrome, capillary hemangiomas are solitary lesions and have not been associated with an inherited disorder.