Clinical features of 7 cases of pure spinal epidural cavernous hemangioma / 中国医师进修杂志

ABSTRACT

Objective:To study the clinical features of pure spinal epidural cavernous hemangioma in order to improve the diagnosis and treatment ability.Methods:The clinical data of 7 patients with pure spinal epidural cavernous hemangioma from January 2013 to November 2022 in Xiangyang Central Hospital were analyzed retrospectively.Results:Among the 7 patients, 2 males and 5 females, and the average age was 49.4 years old. Location of the lesion: cervical spine 1 case, thoracic spine 5 cases, and lumbar spine 1 case. One patient had pure radicular symptoms, 4 patients had pure spinal cord symptoms, and the other 2 patients had both myelopathy symptoms and radicular symptoms. T 1 and T 2 weighted images showed equal or slightly longer signals, and the enhanced scans showed uniform enhancement. Before operation, 1 case was misdiagnosed as meningioma, and the patient′s lesion was not carefully identified during operation, so the lesion was mistaken for oozing hemorrhage caused by operation; 2 cases were misdiagnosed as schwannoma. All patients underwent preoperative localization and microsurgical resection of epidural lesions through the posterior median approach. The lesions were completely removed and no significant complications were observed during hospitalization. Before operation, the neurological function Frankel grade C was in 1 case, grade D in 3 cases, grade E in 3 cases; the patients were followed up for 1 to 117 months, at the last follow-up, neurological function Frankel grade D was in 3 cases, grade E in 4 cases, no recurrence was found. Conclusions:The pure spinal epidural cavernous hemangioma is very likely to be misdiagnosed as the schwannoma and meningioma in imaging, the preoperative imaging should be carefully observed. It is recommended to inject methylene blue into the spinous process of the lesion segment before operation and locate the photos to help with precise intraoperative positioning. Once the disease is considered, special attention should be paid when opening the vertebral lamina to remove the epidural fat during the operation. The lesion is prone to bleeding, and is mistakenly believed to be absorbed by the aspirator or bitten together with the epidural fat. Total resection is an effective treatment for this disease, and it should be treated as soon as possible to avoid the influence of acute hemorrhage on the prognosis.