Spinal dumbbell-shaped epidural cavernous hemangioma (CM):report of nine surgical cases and literature review

Background:Spinal dumbbell-shaped epidural cavernous malformation (CM) is a rare, hypervascular entity frequently misdiagnosed for other lesions, leading to unexpected intraoperative bleeding and suboptimal resection. Our study aims to elucidate the demographics, management strategy, and outcome of this vascular disease.Methods:Retrospective review of patients seen in Beijing Tiantan Hospital with symptomatic dumbbell-shaped epidural CM from 2008 to 2013. All lesions were pathologically confirmed after resection. The clinical manifestations, radiographic features, and treatment modalities of these cases were analyzed.Results:We included 9 consecutive patients. Average age was 58 ± 12 years (range:34-79 years), with 66.7％male. Locations of the CMs were:thoracic (n=7, 77.8％), cervical (n=1, 11.1％), and cervicothoracic junction (n=1, 11.1％). Only one case presented with acute manifestations while others experienced chronic progressive spinal cord symptoms. The initial clinical diagnoses were:schwannoma (n=6, 66.7％), cavernous hemangioma (CM) (n=1, 11. 1％), meningioma (n=1, 11.1％), and angioma (n=1, 11.1％). Total resection was achieved in six patients (66.7％), and partial resection in the other three patients (33.3％). Average intraoperative blood loss was 400 ± 300 ml (range:100-1000 ml). During an average follow-up of 71 ± 21 months (range:29-94 months), excellent outcome was achieved in seven cases (77.8％), one partially improved (11.1％), and one deteriorated (11.1％). No patients experienced recurrence of symptoms.Conclusions:Spinal dumbbell-shaped epidural CM is a benign vascular malformation that should be differentiated from other dumbbell-shaped lesions. Accurate preoperative diagnose is challenging as no specific radiographic marker has been established. Total surgical resection should be recommended.

Spinal capillary hemangioma: Report of five surgical cases and literature review

Objective: Capillary hemangioma is a benign vascular malformation that is usually encountered in soft-tissue. Rarely,it may occur in the neuraxis,and spinal capillary hemangioma(SCH) is a rare variant of it. Existing literature on SCH is limited because of its rarity. As a result,epidemiological and clinical characteristics as well as management strategy for SCH are still lacking. Here,we present a report on five patients with pathologically proven SCH,treated in Beijing Tiantan Hospital between 2013 and 2015.Methods: Patients' age,gender,clinical manifestations,radiological features,operative methods,and surgical outcomes were retrospectively reviewed,and an updated review of the literature was also provided. Results: Four patients were men and one was a woman,with a median age at presentation of 43 years(range: 15–66 years). Two lesions were intramedullary,two epidural,and one intradural extramedullary. The thoracic segment was most commonly affected(n = 3,60%),followed by the cervical(n = 1,20%) and lumbar(n = 1,20%) segments. Common symptoms,in descending order,were numbness and paresthesia,limb weakness,and pain. The surgical procedure was successfully performed with total resection of the tumor achieved in 4 patients and subtotal in 1 patient. During an average follow-up period of 32 months(range: 27–43 months),recovery of the clinical symptoms was observed in all five patients. Conclusions: SCH is a rare benign vascular disease,for which surgical resection of the lesion,by the en bloc method,is recommended. Clinically,it usually manifests with progressive myelopathy,but early surgical intervention usually produces good results and may prevent permanent neurological deficits.