OJO  Vol.5 No.10 , October 2015
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.

Cite this paper
Fukano, R. , Iida, Y. , Hasegawa, K. , Yokoyama, Y. , Wada, A. , Takeuchi, S. , Shibuya, K. and Takahashi, H. (2015) Spinal Epidural Cavernous Hemangioma of the Thoracic Spine: A Case Report. Open Journal of Orthopedics, 5, 311-318. doi: 10.4236/ojo.2015.510042.
References
[1]   Hillman, J. and Bynke, O. (1991) Solitary Extradural Cavernous Hemangiomas in the Spinal Canal. Surgical Neurology, 36, 19-24.
http://dx.doi.org/10.1016/0090-3019(91)90127-u

[2]   Wyburn-Mason, R. (1943) Vascular Abnormalities and Tumors of the Spinal Cord and Its Membranes. Kimpton, London, 24-95.

[3]   Aoyagi, N., Kojima, K. and Kasai, H. (2003) Review of Spinal Epidural Cavernous Hemangioma. Neurologia Medico-chirurgica, 43, 471-476.
http://dx.doi.org/10.2176/nmc.43.471

[4]   Hara, K. and Hidaka, K. (2006) Cavernous Hemangioma Growing Continuously from the Spinal Epidural Space into the Paravertebral Muscles: Case Report. No Shinkei Geka, 34, 521-525.

[5]   Kuroiwa, M., Yamamoto, Y., Watanabe, M. and Mochida, J. (2012) Extradural Cavernous Hemangioma at Lumbar Spine: A Case Report. Kanto-Seikei-saigaigekagakkaisi, 43, 412-415. (In Japanese)

[6]   Hachinoda, J., Yasuda, T., Hori, T., Suzuki, K., Kawaguchi, Y. and Kanamori, M. (2012) Epidural Cavernous Hemangioma Arising from Cervicothoracic Spine: Report of a Case. Seikeigeka, 63, 329-332. (In Japanese)

[7]   Ban, M., Akune, H., Mori, T., Takahashi, Y., Imamura, R., Yano, H., Nakamura, T., Saita, Y., Inoue, S., Suenaga, K., Kikuchi, N., Kozuma, M. and Kawano, N. (2011) A Case of Spinal Epidural Cavernous Hemangioma of the Thoracic Spine. Seikeigeka and Saigaigeka, 60, 278-282. (In Japanese)

[8]   Shimokawa, N. and Fu, Y. (2008) A Case of Epidural Cavernous Hemangioma in Cervicothoracic Spine. The Journal of the Medical Society of Spinal Cord Lesion, 21, 88-89. (In Japanese)

[9]   Uchida, K., Yayama, T., Nakajima, H., Hirai, T., Kobayashi, S., Chen, K., Guerrero, A.R. and Baba, H. (2010) Microsurgical Resection of Cavernous Haemangioma around the Thoracic Neuroforamen: A Case Report. Journal of Orthopaedic Surgery, 18, 370-373.

[10]   Anzai, K., Senoo, M., Mizobuchi, M. and Nakamura, H. (2003) A Case of Thoracic Epidural Cavernous Angioma. Journal of Neurosurgery, 12, 508-512. (In Japanese)

[11]   Asaumi, K., Takei, Y. and Kadota, H. (2002) A Case of Dumbbell-Shaped Spinal Epidural Cavernous Hemangioma. Chugoku-Shikoku Seikeigeka Gakkaisi, 14, 181-185. (In Japanese)

[12]   Muroi, A., Akira, M., Hiroyuki, A., et al. (2001) Spinal Extradural Cavernous Hemangioma. Spinal Cord Surgery, 15, 201. (In Japanese)

[13]   Kitahara, J., Yasukawa, Y., Akizuki, A., Takizawa, T. and Kobayashi, H. (2000) A Case Report of Extradural Cavernous Hemangioma in Lumbar Spine Which Had Difficulty in Diagnosis before Surgery. Rinsho-Seikeigeka, 35, 813-815. (In Japanese)

[14]   Suga, T., Murakami, E., Ishizuka, M., Fang, S.N., Yoshioka, K. and Sano, M. (1996) A Case of Acromegaly Associated with Variegated Spinal Disorders. No Shinkei Geka, 24, 927-932

[15]   Inoue, T., Koga, H., Abe, M. and Tabuchi, K. (1995) Solitary Spinal Epidural Cavernous Haemangioma Presenting as Acute Epidural Haematoma. Journal of Clinical Neuroscience, 2, 265-268.
http://dx.doi.org/10.1016/s0967-5868(95)80013-1

[16]   Uchibori, M., Imahori, Y., Mizukawa, N. and Ueda, S. (1990) A Case of Cervical Epidural Cavernous Angioma Mimicking a Disc Herniation. Sekitui-Sekizui Journal, 3, 631-636. (In Japanese)

[17]   Satoh, T., Yamakawa, H., Oka, T., Suzuki, M., Watanabe, T., Tajima, T., Toba, Y. and Asahina, S. (1990) A Case of Thoracic Epidural Cavernous Hemangioma with Vast Vascular Nevi. Seikeigeka, 41, 755-758. (In Japanese)

[18]   Kurose, K., Kishi, H. and Sadatoh, T. (1989) Spinal Epidural Cavernous Hemangioma. Case Report. Neurologia Medico-Chirurgica, 29, 538-542.
http://dx.doi.org/10.2176/nmc.29.538

[19]   Fukushima, M., Nabeshima, Y., Shimazaki, K. and Hirohata, K. (1987) Dumbbell-Shaped Spinal Extradural Hemangioma. Archives of Orthopaedic and Traumatic Surgery, 106, 394-396.
http://dx.doi.org/10.1007/BF00456877

[20]   Ogawa, T., Kikuchi, T., Ikeuchi, S., Sanada, S., Nakajima, T. and Anno, I. (1986) CT Findings in Acute Spinal Epidural Hematoma Caused by a Ruptured Cavernous Angioma. No Shinkei Geka, 14, 687-691.

[21]   Morioka, T., Nakagaki, H., Matsushima, T. and Hasuo, K. (1986) Dumbbell-Shaped Spinal Epidural Cavernous Angioma. Surgical Neurology, 25, 142-144.
http://dx.doi.org/10.1016/0090-3019(86)90282-X

[22]   Yaldiz, C., Asil, K., Ceylan, D. and Erdem, S. (2015) Thoracic Extraosseous Epidural Cavernous Hemangioma. Journal of Korean Neurosurgical Society, 57, 65-67.
http://dx.doi.org/10.3340/jkns.2015.57.1.65

[23]   Li, T.Y., Xu, Y.L., Yang, J., Wang, J. and Wang, G.H. (2015) Primary Spinal Epidural Cavernous Hemangioma: Clinical Features and Surgical Outcome in 14 Cases. Journal of Neurosurgery: Spine, 22, 39-46.
http://dx.doi.org/10.3171/2014.9.SPINE13901

[24]   Jang, D., Kim, C., Lee, S.J., Ryu, Y.J. and Kim, J. (2014) Pure Spinal Epidural Cavernous Hemangioma with Intralesional Hemorrhage: A Rare Cause of Thoracic Myelopathy. Korean Journal of Spine, 11, 85-88.
http://dx.doi.org/10.14245/kjs.2014.11.2.85

[25]   Sharma, M.S., Borkar, S.A., Kumar, A., Sharma, M.C., Sharma, B.S. and Mahapatra, A.K. (2013) Thoracic Extraosseous, Epidural, Cavernous Hemangioma: Case Report and Review of Literature. Journal of Neurosciences in Rural Practice, 4, 309-312.
http://dx.doi.org/10.4103/0976-3147.118772

[26]   Hemalatha, A.L., Ravikumar, T., Chamarthy, N.P. and Puri, K. (2013) A Pure Epidural Spinal Cavernous Hemangioma—With an Innocuous Face but a Perilous Behavior!! Journal of Clinical and Diagnostic Research, 7, 1434-1435.

[27]   Rahman, A., Hoque, S.U., Bhandari, P.B. and Abu Obaida, A.S. (2012) Spinal Extradural Cavernous Haemangioma in an Elderly Man. BMJ Case Reports, 2012, bcr2012006453.
http://dx.doi.org/10.1136/bcr-2012-006453

[28]   Zhong, W.Y., Huang, S.Q., Chen, H.F., Sun, H., Cai, B.W., Liu, Y. and You, C. (2012) Pure Spinal Epidural Cavernous Hemangioma. Acta Neurochirurgica, 154, 739-745.
http://dx.doi.org/10.1007/s00701-012-1295-3

[29]   Sanghvi, D., Munshi, M., Kulkarni, B. and Kumar, A. (2010) Dorsal Spinal Epidural Cavernous Hemangioma. Journal of Craniovertebral Junction and Spine, 1, 122-125.
http://dx.doi.org/10.4103/0974-8237.77677

[30]   Floeth, F., Riemenschneider, M. and Herdmann, J. (2010) In-tralesional Hemorrhage and Thrombosis without Rupture in a Pure Spinal Epidural Cavernous Angioma: A Rare Cause of Acute Lumbal Radiculopathy. European Spine Journal, 19, S193-S196.
http://dx.doi.org/10.1007/s00586-010-1345-6

[31]   Sarikaya-Seiwert, S., Gierga, K., Wessalowski, R., Steigner, H.J. and Hanggi, D. (2010) Solitary Spinal Epidural Cavernous Angiomas in Children Presenting with Acute Neurological Symptoms Caused by Hemorrahage. Journal of Neurosurgery: Pediatrics, 5, 89-93.
http://dx.doi.org/10.3171/2009.7.PEDS09203

[32]   Satpathy, D.K., Das, S. and Das, B.S. (2009) Spinal Epidural Cavernous Hemangioma with Myelopathy: A Rare Lesion. Neurology India, 57, 88-90.
http://dx.doi.org/10.4103/0028-3886.48805

[33]   Iglesias, S., Ayerbe, J., Sarasa, J.L., Sousa, P., Torres, C. and Ruiz-Barnés, P. (2008) Dumbbell-Shaped Spinal Epidural Cavernous Angioma. Case Report and Review of the Literature. Neurocirugia, 19, 248-253.
http://dx.doi.org/10.1016/S1130-1473(08)70228-8

[34]   Marshman, L.A., David, K.M. and Chawda, S.J. (2007) Lumber Extradural Arteriovenous Malformation: Case Report and Literature Review. The Spine Journal, 7, 374-379.
http://dx.doi.org/10.1016/j.spinee.2006.03.013

[35]   Jo, B.J., Lee, S.H., Chung, S.E., Paeng, S.S., Kim, H.S., Yoon, S.W. and Yu, J.S. (2006) Pure Epidural Cavernous Hemangioma of the Cervical Spine That Presented with an Acute Sensory Deficit Caused by Hemorrhage. Yonsei Medical Journal, 47, 877-880.
http://dx.doi.org/10.3349/ymj.2006.47.6.877

[36]   Hatiboglu, M.A., Iplikcioglu, A.C. and Ozcan, D. (2006) Epidural Spinal Cavernous Hemangioma. Neurologia Medico-Chirurgica, 46, 455-458.
http://dx.doi.org/10.2176/nmc.46.455

[37]   Minh, N.H. (2005) Cervicothoracic Spinal Epidural Cavernous Hemangioma: Case Report and Revier of the Literature. Surgical Neurology, 64, 83-85.
http://dx.doi.org/10.1016/j.surneu.2004.10.030

[38]   Cheng, L.T. and Lim, W.E. (2005) Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas. A Case Report. Interventional Neuroradiology, 11, 161-166.

[39]   Nagi, S., Megdiche, H., Bouzaidi, K., Haouet, S., Khouja, N., Douira, W., Sebai, R., Chaabene, S., Zitouna, M. and Touibi, S. (2004) Imaging of Spinal Epidural Cavernous Malformations. Journal of Neuroradiology, 31, 208-213.
http://dx.doi.org/10.1016/S0150-9861(04)96993-3

[40]   D’Andrea, G., Ramundo, O.E., Trillò, G., Roperto, R., Isidori, A. and Ferrante, L. (2003) Dorsal Foramenalextraosseous Epidural Cavernous Hemangioma. Neurosurgical Review, 26, 292-296.

[41]   Goyal, A., Singh, A.K., Gupta, V. and Tatke, M. (2002) Spinal Epidural Cavernous Haemangioma: A Case Report and Review of Literature. Spinal Cord, 40, 200-202.
http://dx.doi.org/10.1038/sj.sc.3101248

[42]   Saringer, W. (2001) Extraforaminal, Thoracic, Epidural Cavernous Haemangioma: Case Report with Analysis of Magnetic Resonance Imaging Characteristics and Revier of the Literature. Acta Neurochirurgica, 143, 1293-1297.
http://dx.doi.org/10.1007/s007010100028

[43]   Félix, A., Koerbel, A., Hanel, R.A., Cichon, E. and Araujo, J.C. (2001) Extradural Spinal Cavernous Haemangioma: Case Report and Review of the Literature. Arquivos de Neuro-Psiquiatria, 59, 440-443.
http://dx.doi.org/10.1590/S0004-282X2001000300025

[44]   Appiah, G.A., Knuckey, N.W. and Robbins, P.D. (2001) Extradural Spinal Cavernous Haemangioma: Case Report and Review of the Literature. Journal of Clinical Neuroscience, 8, 176-179.
http://dx.doi.org/10.1054/jocn.2000.0756

[45]   Shin, J.H., Lee, H.K., Rhim, S.C., Park, S.H., Choi, C.G. and Suh, D.C. (2001) Spinal Epidural Cavernous Hemangioma: MR Findings. Journal of Computer Assisted Tomography, 25, 257-261.
http://dx.doi.org/10.1097/00004728-200103000-00019

[46]   Daneyemez, M., Sirin, S. and Duz, B. (2000) Spinal Epidural Cavernous Angioma: Case Report. Minimally Invasive Neurosurgery, 43, 159-162.
http://dx.doi.org/10.1055/s-2000-8336

[47]   Carlier, R., Engerand, S., Lamer, S., Vallee, C., Bussel, B. and Polivka, M. (1999) Foraminal Epidural Extra Osseous Cavernous Hemangioma of the Cervical Spine: A Case Report. Spine, 25, 225-235.

[48]   Talacchi, A., Spinnato, S., Alessandrini, F., Iuzzolino, P. and Bricolo, A. (1999) Radiologic and Surgical Aspects of Pure Spinal Epidural Cavernous Angiomas. Report on 5 Cases and Review of the Literature. Surgical Neurology, 52, 198-203.
http://dx.doi.org/10.1016/S0090-3019(99)00064-6

[49]   Padolecchia, R. (1998) Epidural Spinal Cavernous Hemangioma. Spine, 23, 1136-1140.
http://dx.doi.org/10.1097/00007632-199805150-00013

[50]   Zevgaridis, D., Büttner, A., Weis, S., Hamburger, C. and Reulen, H.J. (1998) Spinal Epidural Cavernous Hemangiomas. Report of Three Cases and Review of the Literature. Journal of Neurosurgery, 88, 903-908.
http://dx.doi.org/10.3171/jns.1998.88.5.0903

[51]   Padovani, R. (1997) Cavernous Angiomas of the Spinal District: Surgical Treatment of 11 Patients. European Spine Journal, 6, 298-303.
http://dx.doi.org/10.1007/BF01142674

[52]   Bavbek, M., Yurt, A., Caner, H. and Altinors, N. (1997) An Unusual Dumbbell Form of Cavernous Hemangioma of the Cervical Spine. Kobe Journal of Medical Sciences, 43, 57-63.

[53]   Yettou, H., Vinikoff, L., Baylac, F. and Marchal, J.C. (1996) Spinal Epidural Cavernous Angioma. Apropos of 2 Cases. Review of the Literature. Neurochirurgie, 42, 300-304.

[54]   Faleh-Tamimi, A. and Tamimi, S.O. (1995) Extensive Epidural Hemangioma with Skin and Bone Involvement. A Case Report. Spine, 20, 2470-2472.
http://dx.doi.org/10.1097/00007632-199511001-00018

[55]   Harrington Jr., J.F., Khan, A. and Grunnet, M. (1995) Spinal Epidural Cavernous Angioma Presenting as a Lumbar Radiculopathy with Analysis of Magnetic Resonance Imaging Characteristics: Case Report. Neurosurgery, 36, 581-584.
http://dx.doi.org/10.1227/00006123-199503000-00018

[56]   Lanotte, M., Massaro, F., Faccani, G., Forni, M. and Valentini, M.C. (1994) Dumbbell-Shaped Spinal Epidural Cavernous Angioma. Case Report. The Italian Journal of Neurological Sciences, 15, 429-432.
http://dx.doi.org/10.1007/BF02339907

[57]   Isla, A. (1993) Spinal Epidural Hemangiomas. Journal of Neurosurgical Sciences, 37, 39-42.

[58]   Haimes, A.B. and Krol, G. (1991) Dumbbell-Shaped Spinal Cavernous Hemangioma: A Case Report. American Journal of Neuroradiology, 12, 1021-1022.

[59]   Morello, A., Tumbiolo, A., Pinto, G. and Lo Duca, B. (1991) Cavernous Angioma of the Spinal Dura. Journal of Neurosurgical Sciences, 35, 31-35.

[60]   Lee, J.P., Wang, A.D., Wai, Y.Y. and Ho, Y.S. (1990) Spinal Extradural Cavernous Hemangioma. Surgical Neurology, 34, 345-351.
http://dx.doi.org/10.1016/0090-3019(90)90013-F

[61]   Franz, K., Lesoin, F., Leys, D., Krivosic, I. and Jomin, M. (1987) Spinal Epidural Dumbbell-Shaped Cavernous Angioma. Revue Neurologique, 143, 298-300.

[62]   Ojeda, V.J. and Arandia, E.G. (1983) Primary Extradural Neoplasms Causing Spinal Cord Compression. Australian and New Zealand Journal of Surgery, 53, 77-83.
http://dx.doi.org/10.1111/j.1445-2197.1983.tb02401.x

[63]   Richardson, R.R. and Cerullo, L.J. (1979) Spinal Epidural Cavernous Hemangioma. Surgical Neurology, 12, 266-268.

[64]   Lechevalier, B., Derlon, J.M., Houtteville, J.P., Théron, J. and Prévot, P. (1979) Associated Vertebral Angioma and Epidural Cavernoma. Revue Neurologique, 135, 237-244.

 
 
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