Pure epidural extraosseous cavernous hemangioma with thoracic myelopathy: case report and review of literature.

INTRODUCTION: Pure epidural spinal cavernous hemangiomas are rare, benign vascular tumors that account for approximately 4% of all spinal epidural tumors. Due to their dumbbell shape and propensity for foraminal invasion, they are often misdiagnosed and inadequately treated. We present a case of a 58-year-old male with extra-osseous cavernous hemangioma to better aid in diagnosis and management of these lesions. CASE PRESENTATION: A 58-year-old male presented with chronic lower back pain, progressive lower extremity weakness, T10 sensory level, absent lower extremity proprioception, hyperreflexia, and an episode of bowel incontinence. Imaging demonstrated T7-T10 homogenous dorsal epidural mass causing cord signal change. He underwent resection with histopathologic exam revealing a pure epidural cavernous hemangioma. CONCLUSION: Spinal epidural cavernous hemangiomas are exceedingly rare lesions that are often misdiagnosed as nerve sheath tumors and meningiomas. Common features include chronic pain and myelopathy as well as T1 isodensity, T2 hyperintensity, and homogenous enhancement. Uniquely, they present as a lobulated, spindled shape with tapered ends in the dorsal epidural space. Both gross and subtotal resection result in favorable neurologic outcomes.

Primary epidural lumbar Ewing sarcoma presenting as cauda equina syndrome in an adult patient who underwent surgical decompression: A case report / Sarcoma de Ewing epidural lumbar primario que se presenta como síndrome de la cola de caballo en un paciente adulto que se sometió a descompresión quirúrgica: informe de caso clínico

Ewing sarcoma (ES) is a rare primary neoplasm in the lumbar adult spine and may mimic a benign tumor. In this case, after a patient's three-month history of lower back pain and rapidly progressing leg numbness and weakness, magnetic resonance imaging (MRI) showed a mass in the third lumbar vertebra. At a two-month follow-up, imaging showed a fracture, compression and lesion enlargement. Decompression and fixation confirmed ES, and the patient began combined radiotherapy and chemotherapy. Two months postoperatively, residual ES was suspected on MRI. The patient underwent a second surgery, and histopathology confirmed necrosis. A six-month follow-up after the first surgery showed no tumor recurrence. This case supports the inclusion of ES in the differential diagnosis of pathologic spinal fracture. Early decompression and spinal fixation are critical for preserving neurologic and spinal functions in ES complicated by a compression fracture. Combined adjuvant radiotherapy and chemotherapy remain the standard therapeutic strategy (AU)

El sarcoma de Ewing (SE) es una neoplasia primaria rara de la columna vertebral adulta lumbar y puede confundirse con un tumor benigno. En este caso, tras un historial del paciente de 3 meses de dolor en la parte inferior de la espalda y una rápida progresión de entumecimiento y debilidad en las piernas, una resonancia magnética (RM) mostró la presencia de una masa en la tercera vértebra lumbar. En un seguimiento de 2 meses, la imagen reveló una fractura, compresión y un agrandamiento de la lesión. La intervención de descompresión y fijación confirmó el SE, y el paciente inició una pauta combinada de radioterapia y quimioterapia. Dos meses después de la intervención, se sospechó SE residual en una RM. El paciente se sometió a una segunda intervención quirúrgica y la histopatología confirmó necrosis. Un seguimiento de 6 meses después de la primera intervención no mostró recidiva del tumor. Este caso respalda la inclusión del SE en el diagnóstico diferencial de las fracturas patológicas de la columna vertebral. La descompresión y fijación tempranas de la columna vertebral resultan cruciales para preservar las funciones neurológicas y vertebrales en el SE complicado con una fractura por compresión. El tratamiento combinado complementario de radioterapia y quimioterapia sigue siendo la estrategia terapéutica de referencia (AU)

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

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.

Pure extraosseous spinal epidural cavernous hemangioma presenting with acute paraplegia: a case report.

INTRODUCTION: Spinal hemangiomas are benign vascular tumors that most commonly originate from the osseous structures of the spinal column. Epidural spinal hemangiomas without osseous involvement are uncommon and are classified as pure epidural spinal hemangiomas. Extraosseous spinal epidural cavernous hemangiomas are rarely described and among available reports; most patients present with slowly progressive neurological symptoms. Herein, we present a novel case of acute neurological dysfunction from a pure spinal epidural hemangioma that was managed through surgical resection with good neurological recovery at follow-up. CASE PRESENTATION: A 45-year-old previously healthy man presented to the emergency room with sudden inability to ambulate and was found to have bilateral lower extremity weakness. Magnetic resonance imaging of the spine demonstrated an epidural mass extending out of the right T5/6 neural foramen. The mass enhanced heterogeneously, and the preoperative diagnosis favored an atypical schwannoma. The lesion was surgically removed en-bloc through a midline posterior decompression with instrumentation. Histopathologic examination confirmed cavernous hemangioma pathology. Within 6 weeks of the surgical intervention, the patient had regained full sensorimotor function and these effects were durable through long term follow-up. DISCUSSION: Pure spinal epidural hemangiomas are rare and generally have an insidious clinical course. This case report highlights that these uncommon lesions may present with substantial and acute neurological dysfunction requiring urgent neurosurgical intervention. This should prompt clinicians to consider cavernous hemangioma in the differential diagnosis of patients presenting with acute neurological deterioration and an epidural spinal tumor.

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

BACKGROUND: Spinal 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 DESCRIPTION: A 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. CONCLUSIONS: When 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.

Tratamiento quirúrgico de las metástasis espinales epidurales / Surgical Treatment for Epidural Spine Metastasis

Introducción:Los tumores metastásicos son los más comunes de la columna vertebral.Objetivo:Evaluar los resultados quirúrgicos de pacientes con metástasis espinales epidurales, según dolor pre-y posoperatorio, estado neurológico e índice de discapacidad.Métodos: Estudio descriptivo de tipo longitudinal retrospectivo en una muestra de 34 pacientes de 20 o más años de edad ‒universo conformado por 62 pacientes‒con metástasis espinal, atendidos en el hospital "Hermanos Ameijeiras" entre enero 2016-marzo 2018 y operados con técnica de descompresión por corpectomía y fijación de columna. Se comprobóla intensidad del dolor mediante la escala Denis;el estado neurológico mediante la escala de Frankel y el porcentaje de discapacidad a través de la escala Oswestry. Se aplicaron pruebas de significación estadística. La investigación cumplió con los principios de la Declaración de Helsinski.Resultados:predominaron los pacientes de 40 a 59 años (64,7 por ciento) y sexo masculino (67,6 por ciento). El tumor primario más frecuente fue el hematopoyético (41,2 por ciento), con afectación del segmento torácico (57,9 por ciento). La técnica criolla, la más empleada con el 44,1 por ciento. En el preoperatorio la mayoría se encontraban en Denis III, con Frankel D y 66,2 por ciento de discapacidad. En la evaluación posoperatoria la mayoría se encontraban en un Denis entre 0 y 1, Frankel E con conservación del estado neurológico y 31,4 por ciento de incapacidad (p= 0,000). Conclusiones:El tratamiento quirúrgico de los pacientes con metástasis vertebral por medio de instrumentación y descompresión tiene beneficios clínicos, sobre todo, la mejora del dolor y de la función neurológica(AU)

Introduction: Metastatic tumors are the most frequent in the spine. Objective: To evaluate surgical results in patients with epidural spine metastatic tumors, according to pain before and after surgery, their neurological status, and disability index. Methods: This is a retrospective longitudinal descriptive study in a sample of 34 patients older than 20 years- longitudinal descriptive study in a sample of 34 patients aged 20 or over from a universe made up of 62 patients. They had spinal metastases, they were treated at Hermanos Ameijeiras hospital from January 2016 to March 2018. They underwent surgery with a decompression technique by corpectomy and spinal fixation. Pain intensity was verified using Denis scale; neurological status using Frankel scale and the percentage of disability using Oswestry scale. Statistical significance tests were applied. The investigation complied with the principles of Declaration of Helsinki. Results: Patients aged 40 to 59 years (64.7percent) and male (67.6 percent) predominated. The most frequent primary tumor was hematopoietic (41.2 percent), with involvement of the thoracic segment (57.9 percent). The Cuban technique was the most used (44.1 percent). During the preoperative period, the majority were in Denis III, with Frankel D and 66.2 percent were disabled. At the postoperative evaluation, the majority were in Denis between 0 and 1, Frankel E with preservation of neurological status and 31.4 percent of disability (p= 0.000). Conclusions: Surgical treatment of patients with vertebral metastases by means of instrumentation and decompression has clinical benefits, above all, the improvement of pain and neurological function(AU)

Minimally Invasive Resection of Spinal Tumors with Tubular Retractor: Case Series, Surgical Technique, and Outcome.

BACKGROUND: Traditional laminectomy for excision of spinal tumors involves extensive dissection of the midline spinous ligaments, greater blood loss, and risk of delayed segmental instability. The minimally invasive technique of spinal tumor resection using tubular retractors can achieve safe and complete tumor resection while preserving the structural and functional integrity. The authors present their experience of minimally invasive spinal surgery for spinal tumors in this case series. METHODS: The authors retrospectively reviewed 41 consecutive spinal tumor cases operated by the MISS-Key Hole technique using the tubular retractor system at Sree Utharadom Thirunal Hospital, Kerala, India between January 2015 and January 2020. Preoperative clinical findings, surgical technique, operative statistics, complications, and patient outcomes were analyzed in detail. RESULTS: We could successfully achieve gross total resection in 39 cases (95.12%) and subtotal resection in 2 cases. There were 4 cervical, 1 craniovertebral junction, 20 thoracic, 14 lumbar, and 2 sacral lesions, of which 4 were extradural, 1 extradural foraminal, 33 intradural, and 3 dumbbell lesions. The Modified McCormick Scale at 12 weeks had improved by 1-2 scales in all but 2 patients. There was no cerebrospinal fluid leak, pseudomeningocele, or infection in our series. CONCLUSIONS: This series demonstrates the feasibility, safety and effectiveness of the keyhole approach for excision of intradural and extradural spinal tumors extending up to 2 levels. Careful case selection, good preoperative planning, meticulous microsurgical resection, and watertight dural closure are crucial for successful outcome. Early mobilization, less blood loss, and avoidance of delayed instability are the advantages of minimally invasive spinal surgery when compared with open surgery.

What Predicts the Prognosis of Spinal Metastases in Separation Surgery Procedures?

BACKGROUND: Separation surgery is performed to provide a safe gap between the epidural tumor and spinal cord for postoperative stereotactic body radiotherapy (SBRT) in cases of spinal metastases. However, there is a gap in evidence regarding sufficient tumor resection in separation surgery. We describe the prognoses according to the extent of resection in separation surgery. METHODS: This retrospective study included 36 consecutive patients who underwent separation surgery and postoperative SBRT between December 2016 and December 2019 at a single center. Local control (LC), overall survival (OS), distance of separation (DS), and quality-of-life parameters were analyzed. P values <0.05 were considered statistically significant. RESULTS: Patients were assigned to the aggressive resection group (ARG, n = 18) or moderate resection group (MRG, n = 18), with estimated LC and OS at 1 year of 79.0% and 75.9%, respectively. There were no significant differences between ARG and MRG in estimated LC (85.9% vs. 72.2%; P = 0.317) or OS (69.3% vs. 80.9%, P = 0.953) at 1 year. All 5 patients in MRG who developed local progression had less satisfactory tumor resection with DS <3 mm. A borderline significant difference in estimated LC at 1 year was noted between individuals with DS <3 mm and those with DS ≥3 mm (51.9% vs. 100.0%; P = 0.053) in MRG. There was no statistical difference between ARG and MRG in quality-of-life parameters. CONCLUSIONS: Moderate resection of ventral dural mass did not significantly reduce patients' prognosis in separation surgery. However, the minimal distance between the postoperative residual epidural tumor and spinal cord should be ≥3 mm.

A movement disorder specialist gets a taste of his own medicine.

We present a case in which a movement disorder neurologist developed two different hyperkinetic movements due to corticospinal tract hyperexcitability, which resolved completely with surgical removal of an epidural spinal canal tumor. The first-hand description of these movements creates a unique opportunity for enhanced insight into these complex movement phenomena.

Outcome of Epidural Hematoma: Lessons from Solitary Fibrous Tumor/Hemangiopericytoma.

BACKGROUND: Intracranial solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is rare. In this report, a case of epidural hematoma (EDH) that eventually evolved into SFT/HPC is presented. We describe the possible association between the 2 diseases, which has not been previously reported. CASE DESCRIPTION: A 40-year-old man suffered from an EDH in the right parietal area 12 years ago and accepted conservative treatment. Follow-up computed tomography (CT) scan shows that the density of the right EDH gradually changed from uniform slightly lower density to mixed density. A new CT scan revealed an epidural mass extending to the subcutaneous with local bone destruction. An operation was performed via a large right parietal craniotomy, and the final diagnosis was World Health Organization grade III SFT/HPC after histopathologic examination and immunohistochemical verification. The patient died of deterioration of brain disease 3 months after the final diagnosis. CONCLUSIONS: To our knowledge, this is the first report that HPC occurred in the epidural cavity. We are the first time to describe the possible association between EDH and HPC.

Clinical features and long-term surgical outcomes of pure spinal epidural cavernous hemangioma-report of 23 cases.

BACKGROUND: Pure spinal epidural cavernous malformation (CM) is a rare hypervascular disease that is easily misinterpreted as other imaging-similar epidural lesions. The demographic characteristics, therapeutic strategies, and surgical outcomes associated with this vascular entity remains unclear. METHODS: A retrospective review of patients with pathologically proven, pure epidural CM from 2001 to 2018 was conducted. All data that included clinical manifestations, radiographic features, and treatment modalities were analyzed. RESULTS: Twenty-three consecutive patients with an average age of 51.5 ± 8.4 years old (range 38-70 years old) were included; of these, 52.2% were female patients. Clinical manifestation included chronic progressive nerve root disturbance syndrome in 7 patients (30.4%) and myelopathy in 16 patients (69.6%). The CM level was predominately thoracic (n = 14, 60.9%) or lumbar (n = 6, 26.1%), with the dorsal epidural space (n = 14, 60.9%) the most common site. The initial clinical diagnoses were schwannoma (n = 11, 52.2%), meningioma (n = 5, 21.7%), angioma (n = 3, 13.1%), recurrent CMs (n = 2, 8.7%), and metastatic tumor (n = 1, 4.3%). Fifteen lesions (65.2%) were isointense on T1-weighted images, and all lesions were hyperintense on T2-weighted images, with homogenously strong enhancement observed in 17 lesions (73.9%). Total resection was achieved in 18 patients (78.3%) and usually resulted in excellent clinical outcomes (n = 21, 91.3%). No patients experienced recurrence of symptoms, and lesion relapse during follow-up. CONCLUSION: Total surgical removal of epidural CM can usually achieve satisfactory outcomes in patients with a chronic clinical course and should be recommended. Subtotal removal of tumors can also benefit patients, and guaranteed a long recurrent free time after surgery. A good preoperative neurological condition usually leads to good outcomes.

The clinical utility of the Spinal Instability Neoplastic Score (SINS) system in spinal epidural metastases: a retrospective study.

STUDY DESIGN: A retrospective study. OBJECTIVES: This study assessed the clinical utility of the Spinal Instability Neoplastic Score (SINS) in relation to the surgical treatment of spinal epidural metastasis and factors important for surgical decision-making. These factors include epidural spinal cord compression (ESCC), patient prognosis and neurologic status. SETTING: Queen Elizabeth II Health Sciences Centre, Halifax, Canada. METHODS: We identified 285 patients with spinal metastatic disease. Data were extracted through a retrospective review. SINS and ESCC were scored based on CT and MRI, respectively. RESULTS: Patients were grouped into stable (35%), potentially unstable (52%), and unstable (13%) groups. The overall incidence of metastatic spinal deformity was 9%. Surgical interventions were performed in 21% of patients, including decompression and instrumented fusion (70%), decompression alone (17%), percutaneous vertebral augmentation (9%), and instrumented vertebral augmentation (5%). The use of spinal instrumentation was significantly associated with unstable SINS (p = 0.005). Grade 3 ESCC was also significantly associated with unstable SINS (p < 0.001). Kaplan-Meier analysis revealed that SINS was not a predictor of survival (p = 0.98). In the radiotherapy-alone group, a significant proportion of patients with potentially unstable SINS (30%) progressed into unstable SINS category at an average 364 ± 244 days (p < 0.001). CONCLUSION: This study demonstrated that more severe categories of SINS were associated with higher degrees of ESCC, and surgical interventions were more often utilized in this group with more frequent placement of spinal instrumentation. Although SINS did not predict patient prognosis, it correlates with the progression of metastatic instability in patients treated with radiotherapy.

Cervical-Thoracic Epidural Giant Cell Reparative Granuloma: Case Report and Review of the Literature.

BACKGROUND: Giant cell reparative granuloma (GCRG) is a rare benign tumor. The jawbone is the most common site of occurrence, followed by sphenoid bone, craniofacial bone, hand and foot bones. The etiology of GCRG is unknown but may be related to an intraosseous hemorrhage following trauma. Despite its benign nature, it could be locally aggressive. To our knowledge, no spinal epidural GCRG case has been reported. CASE DESCRIPTION: A case of man aged 32 years who presented with upper right limb numbness and weakness. Computed tomography showed a round soft tissue mass in the spinal canal at the C7-T1 level. The mass showed isointensity on T1-weighted images, hypointensity on T2-weighted images, and significant enhancement on postcontrast T1-weighted images. The mass localized in the epidural space and was surgically resected. The histologic diagnosis was consistent with GCRG. CONCLUSIONS: Spinal epidural GCRG is rare and is hardly considered in the differential diagnosis. Preoperative diagnosis of GCRG is challenging, and the definitive diagnosis could only be made by pathological examination. Surgical resection is probably an effective therapy for relief of symptoms.

Endoscope-assisted anterolateral approach to a recurrent cervical spinal chordoma.

BACKGROUND: The anterolateral approach (ALA) enables to access the craniovertebral junction (CVJ), lower and middle clivus, jugular foramen, and cervical spine from a lateral perspective. It is particularly indicated when dealing with extradural bone tumors. Other rare indications are represented by spondylotic myeloradiculopathy and vascular diseases. METHOD: We describe here the steps to safely perform an anterolateral approach along with a brief description of its indications and limits. CONCLUSION: ALA represents a valid option to treat cervical spine and CVJ bone tumors such as chordomas. Its knowledge can improve the process of approach selection when dealing with such complex cases.

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors.

OBJECTIVE: Our objective was to determine the safety, efficacy, and surgical outcome of an extensive posterolateral approach for giant spinal epidural tumors. MATERIALS AND METHODS: Our clinical study included 12 patients with various giant primary tumors and metastases of the spine, who underwent surgery between 2008 and 2019. The surgical procedure consisted of costotransversectomy, laminectomy, corpectomy, tumor resection, spinal column stabilization, and reconstruction. Neurological status examination and pain assessment were recorded at the time of admission, upon discharge and at outpatient check-up. RESULTS: In our clinical sample, there were no major perioperative complications. All patients were discharged from the intensive care unit back to the hospital department within a week after the surgery. Postoperative follow-up showed no deterioration of neurological status. Furthermore, there was a moderate to significant improvement of paraparesis in all patients for weeks after surgery. The most notable improvement was significant pain relief in all the patients. None of the patients had issues with failure of the implanted hardware. Two patients died less than six months after the surgery due to the progression of the primary malignant process. CONCLUSION: An extensive posterolateral approach to giant spinal epidural tumors is an effective one-step approach. It presents a good compromise between invasiveness and sufficient exposure for both tumor resection and spinal column reconstruction. Good short-term clinical improvement can be achieved, but the long term results depend on the advancement of the initial disease. Careful evaluation and selection of patients are necessary to achieve clinical improvement and prolonged life expectancy, and the best results are achieved with a multidisciplinary approach.

Analysis of seven prognostic scores in patients with surgically treated epidural metastatic spine disease.

BACKGROUND: Prognostic scores have been proposed to guide the treatment of patients with metastatic spine disease (MSD), but their accuracy and usefulness are controversial. The aim of this study was to evaluate seven such prognostic scoring systems. The following prognostic scores were compared: Tomita, Van der Linden (VDL), Bauer modified (BM), Oswestry Spinal Risk Index (OSRI), Tokuhashi original (T90), Tokuhashi revised (TR05), and modified Tokuhashi revised (TR17). METHODS: We retrospectively reviewed all our patients who underwent surgery for spinal metastases, February 2008-January 2015. We classified all 223 patients into the predicted survival-time categories of each of the 7 scoring systems and then tallied how often this was correct vis-à-vis the actual survival time. Accuracy was also assessed using receiver operating characteristic (ROC) analysis at 1, 3, and 12 months. RESULTS: The median (95% CI) survival of the 223 patients was 13.6 (7.9-19.3) months. A groupwise ROC analysis showed sufficient accuracy for 3-month survival only for TR17 (area under the curve [AUC] 0.71) and for 1-year survival for T90 (AUC 0.73), TR05 (AUC 0.76), TR17 (AUC 0.76), Tomita (AUC 0.77), and OSRI (AUC 0.71). A pointwise ROC score analysis showed poor prognostic ability for short-term survival (1 and 3 months) with sufficient accuracy for T90 (AUC 0.71), TR05 (AUC 0.71), TR17 (AUC 0.71), and the Tomita score (AUC 0.77) for 1-year survival. CONCLUSION: The TR17 was the only prognostic system with acceptable performance here. More sophisticated assessment tools are required to keep up with present and future changes in tumor diagnostics and treatment.

Epidural cavernous haemangioma during pregnancy: a case report and a literature review.

Cavernous haemangiomas are benign vascular malformations that can locate in the central nervous system. The epidural spinal location remains unusual. Pregnancy is known to be a precipitating factor. The aim of this study is to review general aspects of these lesions and specific facts about their relationship to pregnancy. A 32-year-old full-term pregnant woman is managed during early labor for a progressive spinal cord compression syndrome. After delivery, exploration by a lumbar MRI found an epidural vascular dorsal mass. Surgical exploration and histopathological examination confirmed the diagnosis of epidural cavernous haemangioma. The patient achieved complete recovery after 1 month. Spinal cavernous haemangiomas are rare malformations. Specific mechanisms seems to be involved in their growth during pregnancy. Although clinical and radiological presentation are spectacular and misleading, the prognosis is generally good, and urgent surgical treatment during pregnancy is usually not indicated.

Pure Lumbar Epidural Cavernous Hemangioma with Contralateral Symptoms Complicated by Spondylolisthesis.

Pure spinal epidural cavernous hemangioma with contralateral symptoms is rarely reported. It will be very difficult to diagnose when it is complicated by contralateral symptoms. A 56-year female presented with pure lumbar epidural cavernous hemangioma with contralateral symptoms. Physical examination and imaging including X-ray, CT and MRI, suggested that it is a hemangioma complicated by spondylolisthesis. Laminectomy and exploration was performed. Postoperative X-ray showed satisfactory interbody fusion and reduction of spondylolisthesis. The patient was fully recovered four months postoperatively. Histopathological examination showed that the mass was epidural cavernous hemangioma.

Spinal angiolipomas in pregnancy: Natural history and surgical treatment.

Spinal angiolipomas (SALs) are rare extradural tumors frequently located at the level of the thoracic spine and they are associated with spinal cord compromise that might result in severe myelopathy. While the first macroscopic description dates 1890, histologically these tumors where not described as angiolipomas until 1986 by Haddad et al. Occurrence in pregnancy is even more infrequent. Since their first macroscopic description, spinal angiolipomas were reported anecdotally in pregnant women. We present a case of spinal angiolipoma in pregnancy with confirmed histologic diagnosis. In the present paper, we reviewed the literature regarding spinal angiolipomas in order to characterize their clinical manifestation, natural history, radiologic and histologic appearance. We add also a further case of spinal angiolipoma in a pregnant woman. Finally, we provide suggestions for the management of such rare tumors in pregnancy.