Dumbbell-shaped thoracic epidural capillary hemangioma mimicking schwannoma: a case report.

BACKGROUND

Spinal epidural hemangiomas are rare benign vascular lesions. A dumbbell configuration defined by extension through the neural foramen with both intraspinal and extraspinal components is most commonly associated with schwannomas. Dumbbell-shaped capillary hemangiomas are exceptionally rare and can pose significant diagnostic challenges.

CASE PRESENTATION: A 66-year-old woman presented with a one-year history of back pain and progressive bilateral lower-limb weakness that progressed to a bedridden state. Imaging revealed a dumbbell-shaped lesion extending from D3 to D5 with a large paravertebral component measuring 4.3 × 3.6 × 5.7 cm. A combined D3-D5 laminectomy and right posterolateral thoracotomy was performed. The tumor was markedly hypervascular intraoperatively, and gross total resection was achieved. Recent coronary artery bypass grafting and dual antiplatelet therapy increased the operative hemorrhagic risk. Postoperatively, the patient demonstrated neurological improvement with restoration of bladder control and regained ambulation with a walker.

CONCLUSIONS

Dumbbell capillary hemangiomas can mimic schwannomas radiologically yet carry substantial hemorrhagic risk. Multidisciplinary surgical planning is essential for safe management.