- Department of Neurological Surgery, University of California-Davis, 4860 Y. Street, Suite 3740, USA
- Department of Pathology, University of California-Davis, 2805 50th Street, Sacramento, CA. 95817, USA
Kee D. Kim
Department of Neurological Surgery, University of California-Davis, 4860 Y. Street, Suite 3740, USA
DOI:10.4103/2152-7806.155701Copyright: © 2015 Liu JJ 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: Liu JJ, Lee DJ, Jin L, Kim KD. Intradural extramedullary capillary hemangioma of the cauda equina: Case report and literature review. Surg Neurol Int 22-Apr-2015;6:
How to cite this URL: Liu JJ, Lee DJ, Jin L, Kim KD. Intradural extramedullary capillary hemangioma of the cauda equina: Case report and literature review. Surg Neurol Int 22-Apr-2015;6:. Available from: http://sni.wpengine.com/surgicalint_articles/intradural-extramedullary-capillary-hemangioma-cauda-equina-case-report-literature-review/
Background:Capillary hemangiomas are benign vascular tumors that rarely occur in the neuraxis. When encountered in the spine, prompt diagnosis and complete resection is crucial. On rare instances, these lesions can acutely hemorrhage, leading to sudden neurological decline. To date, there are only 16 reported cases of intradural capillary hemangiomas in the cauda equina.
Case Description:We report a case of an intradural extramedullary cauda equina capillary hemangioma that resulted in back pain and lower extremity motor deficit. Initial magnetic resonance (MR) imaging demonstrated a bilobular intradural L3-4 cauda equina lesion. The lesion was isointense on T1-weighted imaging, mildly hyperintense on T2-weighted images and avidly enhancing after gadolinium administration. Pathology confirmed the diagnosis of capillary hemangioma.
Conclusion:Early diagnosis and treatment of this patient resulted in complete resection of the tumor and return of lower extremity motor function. Capillary hemangiomas should be considered in the differential diagnosis of cauda equina lesions. En bloc resection of these lesions is the mainstay of treatment.
Keywords: Capillary hemangioma, cauda equine, intradural, lumbar
Vascular malformations make up approximately 2–7% of all spinal space-occupying lesions.[
When encountered in the neuraxis, they are usually seen occupying the epidural space, spinal cord, meninges, or cauda equina. Intradurally, they most commonly occur within the cauda equina or conus medullaris, intimately involved with the nerve roots. In rare cases, there is intraneural growth within the confines of the nerve root sheath.[
A 53-year-old presented with a one year history of back pain and subjective weakness of his right leg. He also had gradual increase in right leg pain involving the posterior aspect of his leg down to his ankle with numbness of his entire right foot. He had no history of bowel incontinence but had complaints of impotence, increased urinary frequency throughout the day, and nocturia. On neurological examination, his motor strength was objectively full throughout the bilateral upper and lower extremities except for a 4+/5 left great toe extension. Deep tendon reflexes were notable for a hyporeflexic left achilles reflex. No pathological reflexes were present.
A magnetic resonance imaging (MRI) of the lumbar spine revealed a bilobular, intradural extramedullary cauda equina lesion at the L3-L4 level that displaced the cauda equina anteriorly. This lesion measured 19 × 12 mm in the sagittal view and 12 × 14 mm in the axial view. On T1-weighted images, the lesion was isointense to the cauda equina [
The patient underwent a L3-4 laminectomy with a midline durotomy. Immediately after the dura was opened, the lesion was visualized. Once the lesion was exposed in all directions, a nerve root was noted to be coursing directly through the tumor. This traversing nerve root was stimulated with resultant right hip flexor firing. The decision was made to transect the intimately involved nerve root to help achieve a complete en bloc resection of the lesion.
Postoperatively, the patient did not experience any new neurological deficits despite sacrificing the intralesion nerve root. He improved to full strength in his lower extremities including left great toe extension without new sensory deficits. Postoperative MRI of the lumbar spine showed a gross total resection of the intradural lesion [Figure
Grossly, the lesion was tan to pink with an irregular architecture. Microscopic examination showed a well-encapsulated, highly vascular lesion [
Intradural capillary hemangiomas of the cauda equina are exceedingly rare.
Radiographically, capillary hemangiomas characteristically show homogeneous enhancement after gadolinium administration on MRI.[
Given the rarity of spinal cord capillary hemangiomas, the natural history is not known. Furthermore, the recurrence or regrowth of central nervous system capillary hemangiomas is extremely rare.[
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