Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 22, 2016
Spinal Epidural Hemangioma
- Background:
- Epidural hemangiomas (EH) are extremely rare, benign lesions. Several types have been described, most commonly cavernous and capillary.
- Clinical Presentation:
- Sudden onset of localized pain, slowly progressing paraparesis, radiculopathy, and focal neurological symptoms are likely due to the proximity of EH to neural structures and the likelihood for neural compression.
- Key Diagnostic Features:
- Lobulated margins, increased T2 signal with rim of low T2 signal intensity, and robust enhancement are helpful in the diagnosis.
- Spinal MRI is the best diagnostic tool, and surgical excision confirms the diagnosis.
- Differential Diagnosis:
- Schwannoma
- Lymphoma
- Granulomatous infections
- Meningioma
- Angiolipomas
- Multiple myelomas
- Pure epidural hematomas
- Epidural extramedullary hematopoiesis
- Treatment:
- Open surgery is the best treatment to address any pain or neurologic symptoms. There is increased risk of intraoperative bleeding.
- Stereotactic radiosurgery has been used as adjuvant therapy for incompletely resected hemangiomas, though more studies on its effectiveness are necessary.