Intradural extramedullary capillary hemangioma with intramedullary component: A case series

Abstract

Rationale: Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological characteristics, and pathological features of capillary hemangioma in the spinal cord and to share our experience for the diagnosis and treatment of intradural extramedullary capillary hemangioma.

Patient concerns: Three patients underwent surgical treatment at our hospital between January 2020 and August 2020. All patients were male[median age at presentation: 57 years (range: 56-60)]. Two patients were experiencing pain and numbness in the lower back, and 1 patient was experiencing numbness and weakness in the left lower limb. The duration of symptoms ranged from 1 to 5 months.

Diagnosis: All patients were diagnosed with spinal cord capillary hemangioma after treatment. All lesions were in an intradural extramedullary location and involved spinal cord components. Two patients had lesions in thoracic segments (T8, Th9-10), and 1 patient had a lesion in lumbar segment (L1).

Interventions: All patients underwent microscopic laminectomy and complete resection of the extramedullary and intramedullary components of the spinal cord capillary hemangiomas.

Outcomes: Postoperatively, all patients experienced transient numbness and pain in the lower limbs, which gradually decreased over time. None of the patients experienced bleeding, severe numbness or pain, or recurrence of symptoms at 3-month follow-up.

Conclusion: Intradural extramedullary capillary hemangioma has unique morphological characteristics. Gross-total resection of the extramedullary and intramedullary components of spinal cord capillary hemangioma is recommended for patients with symptoms of spinal cord compression. Careful preoperative imaging and intraoperative decision-making may help avoid residual lesions or reoperation.

Figure 1.

A 56-year-old man presented with a history of progressive low-back pain and numbness of the right lower limb for 1 month. Preoperative MRI. (A) T1WI sequence shows an isointense lesion; (B) T2WI sequence shows a hyperintense lesion with spinal cord edema; (C and D) Axial and coronal CE-T1WI show a homogeneous enhanced mass compressing the spinal cord.

Figure 2.

Surgical procedure. (A) Subarachnoid tumor with rich-blood supply; (B) the mass was dissected along the margin; (C) abnormal brown tissue on the spinal cord, with a distinct boundary at the pia mater spinalis.

Figure 3.

Postoperative MRI. Postoperative MRI showing a residual intramedullary lesion. MRI = magnetic resonance imaging.

Figure 4.

The second surgical procedure. (A) The pia mater was incised to reveal the intramedullary lesion; (B) the intramedullary lesion was completely resected. (C) Capillary hemangioma accompanied with active cell growth (HE stained, 100× magnification).

Figure 5.

A 56-year-old man presented with a 5-month history of left lower limb numbness and lower limb weakness. (A–C) Preoperative MRI. The lesion is at T8 level. (D) The dura was opened; (E) extramedullary components; (F) an abnormal area is seen on the spinal cord, with a distinct boundary at the pia mater spinalis. (G) Photomicrograph of the tumor specimen (HE stained, 100× magnification). MRI = magnetic resonance imaging.

Figure 6.

A 60-year-old man presented with left back pain and left lower limb numbness for 4 months. (A–C) Preoperative MRI. The lesion is seen at L1. (D) Lobulated capillary hemangioma accompanied with active cell growth (HE stained, 100× magnification). MRI = magnetic resonance imaging.