- Department of Trauma and Emergency, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India
- Department of Neurosurgery, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India
Correspondence Address:
Ashis Patnaik
Department of Pathology and Laboratory Medicine, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India
DOI:10.4103/2152-7806.146962
Copyright: © 2014 Patnaik A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Patnaik A, Mahapatra AK, Banushree C. A rare case of thoracic extradural thrombosed primary cavernous haemangioma in a relatively asymptomatic patient. Surg Neurol Int 15-Dec-2014;5:180
How to cite this URL: Patnaik A, Mahapatra AK, Banushree C. A rare case of thoracic extradural thrombosed primary cavernous haemangioma in a relatively asymptomatic patient. Surg Neurol Int 15-Dec-2014;5:180. Available from: http://sni.wpengine.com/surgicalint_articles/a-rare-case-of-thoracic-extradural-thrombosed-primary-cavernous-haemangioma-in-a-relatively-asymptomatic-patient/
Sir,
Pure spinal epidural cavernous (haem) angiomas (PSECA) arising without any connection with the vertebrae are rare and few cases have been reported in the literature. They usually grow to a considerable size and are usually symptomatic in form of myelopathy with or without radiculopathy features.[
A 16 year old girl presented with complaints of intermittent electric shock like sensation in left side lower limb for last 2 to 3 years. There was no history of weakness, numbness, tightness in either lower limb, bladder or bowel disturbances. On examination, there was no sensory deficit with motor power being grade 5/5 (MRCS scale) in all four limbs. All the jerks were well preserved and normal. Plantar was bilaterally downgoing. MRI thoracic region (T1 weighted) showed an elongated, spindle shaped isointense lesion in posterior aspect of spinal canal at T7-T9 level [
Cavernous hemangiomas account for 3 to 16% of spinal vascular anomalies.[
Our case was exclusive in that in spite of a sizeable lesion at thoracic location, the patient was having very subtle symptoms with radiological features suggesting a more common nerve sheath tumour. The cavernous haemangiomas of spine, although look benign, have a devastating outcome as these usually present with myelopathy features with bladder, bowel dysfunction and most of these do not completely recover following their excision. Fortunately our case had no preoperative neurological deficits and this could be attributed to the thrombosed nature of the lesion. Such thrombosed haemangiomas should be considered in the differential diagnosis of asymptomatic well-defined extradural lesion in a young patient with long standing symptoms.
References
1. Cosgrove GR, Bertrand G, Fontaine S, Robitaille Y, Melanson D. Cavernous angiomas of the spinal cord. J Neurosurg. 1998. 68: 31-6
2. Floeth F, Riemenschneider M, Herdmann J. Intralesional hemorrhage and thrombosis without rupture in a pure spinal epidural cavernous angioma: A rare cause of acute lumbal radiculopathy. Eur Spine J. 2010. 19: S193-6
3. Gutkelch AN. Hemangiomas involving the spinal epidural space. J Neurol Neurosurg Psychiatry. 1948. 11: 199-210
4. Hatiboglu MA, Iplikeioglu AC, Ozcan D. Epidural spinal cavernous angioma. Neurol Med Chir (Tokyo). 2006. 46: 455-8
5. Hemalatha AL, Ravikumar T, Chamarthy NP, Puri K. A pure epidural spinal cavernous hemangioma – with an innocuous face but a perilous behaviour!!. J Clin Diagn Res. 2013. 7: 1434-5
6. Santoro A, Piccirilli M, Bristot R, di Norcia V, Salvati M, Delfini R. Extradural spinal cavernous angiomas: Report of seven cases. Neurosurg Rev. 2005. 28: 313-9
7. Saringer W, Nobauer I, Haberler C, Ungersbock K. Extraforaminal, thoracic, epidural cavernous hemangioma: Case report with analysis of magnetic resonance imaging characteristics and review of the literature. Acta Neurochir (Wien). 2001. 43: 1293-7
8. Satpathy DK, Das S, Das BS. Spinal epidural cavernous hemangioma with myelopathy: A rare lesion. Neurol India. 2009. 57: 88-90