Abstract
Study design:
Case report and review of the literature.
Objective:
To report an unusual case of a spinal intradural extramedullary cavernous angioma (CA), located at the cauda equina, and to compare it with the previously published 22 surgically treated cases in the literature.
Setting:
Ankara, Turkey.
Method:
A 67-year-old man presented with a 4-month history of back pain and sciatica and a 4-week history of progressive lower extremity paresthesia, difficulty walking, and loss of bladder and bowel sphincter control. Neurological examination revealed bilateral hypoesthesia below the T12 dermatome with spastic paraparesis. Magnetic resonance imaging (MRI) of the cauda equina revealed a heterogeneous enhancing intradural extramedullary mass obliterating the spinal canal and expanding the spinal cord. T12 laminectomy and total tumor removal were performed without additional neurological deficit. Pathological examination confirmed the diagnosis of a CA.
Result:
The patient's neurological status improved during postoperative recovery. He was ambulatory without assistance and regained full sphincter control on the eighth postoperative week.
Conclusion:
CAs of the spinal cord are extremely rare lesions. Typically, they present with low back pain and sciatica, neurological deficits, or as a subarachnoid hemorrhage. These lesions have characteristic features on MRI and should be considered in the differential diagnosis of intradural spinal lesions. Following a thorough literature review of reported cases, the authors propose that for patients presenting with severe preoperative neurological signs, immediate microsurgical tumor excision or decompression increases the chance of neurological improvement.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Mastronardi L, Ferrantel L, Scarpinati M, Gigliardi FM, Celli P, Fortuna A . Intradural extramedullary cavernous angioma: case report. Neurosurgery 1991; 29: 924–926.
Harrison MJ, Eisenberg MB, Ullman JS, Oppenheim JS, Camins MB, Post KD . Symptomatic cavernous malformations affecting the spine and spinal cord. Neurosurgery 1995; 37: 195–205.
Roger H, Paillas JE, Bonnal J, Vigorous M . Angiomes de la moelle et des racines. Acta Neurol Psych Belgium 1951; 7: 491–495.
Floris V . Angiomie angiomatosi del sistema nervoso. Lav Neuropsich 1958; 27: 159–179.
Hirsch JF, Pradat P, David M . Cavernous angioma of the cauda equina. Neurochirurgie 1965; 11: 323–327 (Fr).
Pansini A, Lo Re F . Laro caso di angiocavernoma della cauda. Mem Soc Tos Um Chir 1966; 27: 679–696.
Ortner WD, Kubin H, Pilz P . Ein zervikales kavernoeses angiom. Fortschr Roengtenstr 1973; 118: 475–476.
Heimberger K, Schnaberth G, Koos W, Pendl G, Auff E . Spinal cavernous haemangioma (intradural-extramedullary) underlying repeated subarachnoid hemorrhage. J Neurol 1982; 226: 289–293.
Ueda S, Saito A, Inomori S, Kim I . Cavernous angioma of the cauda equina producing subarachnoid hemorrhage. Case report. J Neurosurg 1987; 66: 134–136.
Pagni CA, Canevero S, Forni M . Report of a cavernoma of the cauda equina and review of the literature. Surg Neurol 1990; 33: 124–131.
Ramos Jr F, de Toffol B, Aesch B, Jan M . Hydrocephalus and cavernoma of the cauda equina. Neurosurgery 1990; 27: 139–142.
Mori K, Ishii H, Tomita Y, Nakajima K, Morimoto K, Maeda M . Intradural-extramedullary spinal cavernous angioma – case report. Neurol Med Chir (Tokyo) 1991; 31: 593–596.
Acciarri N, Padovani R, Pozzati E, Gaist G, Manetto V . Spinal cavernous angioma: a rare cause of subarachnoid hemorrhage. Surg Neurol 1992; 37: 453–456.
Sharma R, Rout D, Radhakrishnan VV . Intradural spinal cavernomas. Br J Neurosurg 1992; 6: 351–356.
Bruni P, Massari A, Greco R, Hernandez R, Oddi G, Chiappetta F . Subarachnoid hemorrhage from cavernous angioma of the cauda equina: case report. Surg Neurol 1994; 41: 226–229.
Cervoni L, Celli P, Gagliardi FM . Cavernous angioma of the cauda equina: report of two cases and review of the literature. Neurosurg Rev 1995; 18: 281–283.
Rao PG, Bhaskar G, Hemaratnan A, Srinivas TV . Spinal intradural extramedullary cavernous angiomas: report of four cases and review of the literature. Br J Neurosurg 1997; 11: 228–232.
Duke BJ, Levy AS, Lillehei KO . Cavernous angiomas of the cauda equina: case report and review of the literature. Surg Neurol 1998; 50: 442–445.
Nozaki K, Inomoto T, Takagi Y, Hashimoto N . Spinal intradural extramedullary cavernous angioma: case report. J Neurosurg Spine 2003; 99: 316–319.
Flavigna A, Righesso Neto O, dos Santos JA, Ferraz FA . Cavernous angioma of the cauda equina: case report. Arq Neuropsiquiatr 2004; 62: 531–534.
Hadlich R . Ein fall von Tumor Cavernosus des Rueckenmarks mit besonderer Beruecksichtigung der neueren Theorien ueber die Genesis des kavernom. Virchows Arch 1903; 172: 429–441.
Turner OA, Kernohan JW . Vascular malformation and vascular tumors involving the spinal cord. Arch Neurol 1941; 46: 444–463.
Wang AM, Morris JH, Fischer EG, Peterson R, Lin JCT . Cavernous hemangioma of the thoracic spinal cord. Neuroradiology 1988; 30: 261–264.
Rigamonti D, Drayer BP, Jhonson PC, Hadley MN, Zabramski J, Spetzler RF . The MRI appearance of cavernous malformations (angiomas). J Neurosurg 1987; 67: 518–524.
Fontaine S, Melanson D, Cosgrove R, Bertrand G . Cavernous hemangiomas of the spinal cord MR imaging. Radiology 1988; 166: 839–841.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Er, U., Yigitkanli, K., Simsek, S. et al. Spinal intradural extramedullary cavernous angioma: case report and review of the literature. Spinal Cord 45, 632–636 (2007). https://doi.org/10.1038/sj.sc.3101990
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.sc.3101990
Keywords
This article is cited by
-
Extra-Axial Dural-Based Foramen Magnum Cavernous Malformation: a Rara Avis. Case Report and Literature Review
SN Comprehensive Clinical Medicine (2023)
-
Spinal intradural extramedullary cavernous hemangioma
Neuroradiology (2018)
