Primary spinal extradural cavernous haemangiomas: a report of three cases and review of literature.

INTRODUCTION

Primary spinal extradural cavernous haemangiomas (ECHs) are histologically benign but can behave aggressively by eroding the spine or compress neural elements. They are rare and can be mis-interpreted for other more common epidural lesions. Surgery is the gold standard in management. In this report, we highlight the diagnostic and intraoperative technical considerations needed to achieve a good clinical outcome. In addition, a comprehensive literature review was conducted.

RESULTS

We report three cases (two males and one female) with an average age of 40 years. Two patients presented with radiculopathy and one patient presented with thoracic myelo-radiculopathy. The ECH location was cervico-thoracic in two patients and sacral in one. Pre-operative working radiological diagnosis of the cervico-thoracic lesion with homogenous contrast enhancement was haemangioma, while the other two were schwannoma. Two patients underwent pre-operative CT-guided biopsy, and the diagnosis was confirmed in one. Two patients underwent pre-operative catheter angiography, and embolisation was performed in one. All three patients had complete tumour resection with no recurrence on follow-up imaging (mean 33 months). The histology in all three cases confirmed cavernous haemangioma.

CONCLUSION

Although a rare entity, spinal ECH should be considered in the differential diagnosis of large extradural lesions that extend through the neural foramina. From a surgical viewpoint, wide bony exposure facilitates complete removal of these benign tumours and is associated with better outcomes. Whilst not mandatory, en bloc excisions can help reduce significant blood loss.