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Surg Neurol Int.: Case report of epidural extension of D1-D7 hemangioma on the dorsal side of the spine with congenital skin hemangioma

 Last Update: 2021-10-20
 Source: Internet
 Author: User

Multiple vertebral vascular tumors (MVH) usually involving a plurality of vertebral bodies, occasionally extend into the epidural space
.

They account for 2-3% of all spinal tumors and usually follow an inert, asymptomatic course

A 24-year-old man with multiple spinal hemangioma (MVH) with epidural extension (ie leading to significant spinal cord compression on D1-D3) developed progressive lower extremity paresis for 6 months and congenital at the level of D2-D7 Skin lesions

Patients with congenital skin hemangioma of the chest, arm and forearm (left) (a) front and (b) back
.
Patients with congenital skin hemangioma of the chest, arm and forearm (left) (a) front and (b) back
.

Patients with congenital skin hemangioma of the chest, arm and forearm (left) (a) front and (b) back

At the time of examination, his diffuse exercise intensity of the lower limbs was 3-4/5, the relative sensory level was lower than the D4 level, and there was no sphincter involvement

Chest CT showed irregular osteolytic lesions with thick thickened trabeculae involving the level of the D1 vertebra of D7, including the left 1 to 6 ribs

The axial CT image of the thoracic spine shows the appearance of "dots"
.
The axial CT image of the thoracic spine shows the appearance of "dots"
.

MRI results

On MR, the tumor is low in signal on both T1W and T2W images and is contrast-enhanced (that is, the cervical spinal cord from C7 to D8 is expanded through the intervertebral foramen)
.

A subtle increase in T2W hyperintensity in the spinal cord was also observed at the level of the D2-D3 vertebral body

On MR, the tumor is low in signal on both T1W and T2W images and is contrast-enhanced (that is, the cervical spinal cord from C7 to D8 is expanded through the intervertebral foramen)

The axial T2W image of the MRI dorsal spine showed continuous infiltration of the left costal vertebral joint and adjacent ribs, and the bone marrow signal was significantly changed
.

Invasive epidural/epidural lesions cause a significant space-occupying effect on the spinal cord and show that the spinal cord moves to the right

MRI coronal/STIR image of the back showed continuous involvement of multiple levels of costal vertebral joints on the left
.

Surgery

After D1-D7 laminectomy, a reddish-brown, soft lesion was found with blood vessels
.

The tumor is attached to the dorsal sheath and exhibits lateral, intervertebral foramen, and left paravertebral extension

After D1-D7 laminectomy, a reddish-brown, soft lesion was found with blood vessels

Postoperative X-ray spine (a) AP, (b) side view
.

pathology

Frozen sections (ie, epidural, lamina, paravertebral and skin) are consistent with cavernous hemangioma
.

Histopathological examination revealed cavernous hemangioma (a) dilated and congested vascular spaces of different sizes (b) the dermis showed dilated and congested blood vessels (arrows)
.

The dermis shows hemorrhage (c) bone, and the bone marrow shows a tightly packed dilated vascular space filled with blood
.

Postoperative recovery

The patient recovered smoothly; after 1 week, when he was discharged from the hospital, his condition improved and he was able to walk around without any weakness
.
Two months later, his bilateral muscle strength was 5/5
.

Postoperative adjuvant radiation therapy

Patients receive radiotherapy on the tumor bed after surgery to treat tumors that are difficult to reach during surgery and limit the chance of recurrence
.

discuss

According to the classification of the World Health Organization, vertebral hemangioma is considered a benign bone angiogenic tumor
.
The most common site is the thoracic spine (about 60%), followed by the cervical spine (30%) and lumbar spine (10%).
These lesions are usually limited to the vertebral body, but occasionally may extend to the pedicle, arch, and spinous process
.
It is worth noting that the vast majority of vertebral hemangioma are asymptomatic, and the further epidural extension of vertebral hemangioma can usually be seen in radiographic examination or only in 1% to 2% of cases, resulting in slow Progressive compressive myelopathy or radiculopathy
.

In the case we introduced, the patient had a congenital skin hemangioma at the same level as the vertebral/epidural tumor site
.
However, some documents describe cases of hemangioma in the liver, spleen and other organs associated with spinal cord hemangioma at the same time
.

Magnetic resonance imaging is the most reliable examination for spinal hemangioma
.
It is recommended to perform spinal angiography before surgery and embolization of the blood supply vessel before surgery to avoid the risk of intraoperative bleeding
.
Laminectomy is an effective decompression surgery that does not cause instability or deformity
.
However, if a compression fracture of the vertebral body occurs, vertebroplasty and/or fusion may be required
.

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