Dr. Siddharth Katkade is a highly skilled, world wide trained and dedicated Spine Surgeon with over 10+ years of experience in field of specialised Spine Care and Orthopaedics.
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Introduction: Commonly spinal cavernous hemangioma (CH) is found in vertebral body at thoracic level. Purely extraosseous epidural CH
contributes only 4% of all CH. In addition, these patients usually present in their 3rd–6th decade of life. Here, we report emergently treated rare
case of hemorrhagic extraosseous epidural thoracic CH in a 26-year-old male.
Case Report: A 26-year-old male presented with inability to walk without support with acute onset paraparesis and hypoesthesia below D7 with
positive myelopathy signs. Magnetic resonance imaging showed posterior epidural well-defined homogenous mass from D6-8 region. PET scan
ruled out other primary lesions in body. Intraoperative after D6-8 laminectomy extradural vascular mass was found which was bleeding on touch.
With adequate hemostasis complete mass was excised and sent for sampling which revealed CH. The patient showed gradual clinical recovery
with complete neurological recovery after 3 months with no signs of clinical and radiological recurrence on 2 years of follow-up.
Conclusion: Extraosseous epidural CH is very rare presentation; hence, the differentials of schwannoma, lymphoma, tubercular/pyogenic
epidural abscess, metastasis, and others must always be ruled out. They can present a decade earlier in a case of hemorrhagic CH with rapid
progressive neurological deficit which warrants early surgical decompression like in our case and the foraminal or paravertebral extension needs
foraminotomy or thoracotomy for complete excision.
Keywords: Spinal cavernous hemangioma, extra-osseous, epidural, hemorrhagic, emergency.
Cavernous hemangioma (CH) is not treated as vascular neoplasms rather they are neuroaxial hamartomas or vascular malformations [1]. Majority times they are seen intracranially with supratentotrial region being most common site. Vertebral
location is rare but the most common among 5–12% of spinal lesion. Epidural hemangiomas usually are the extension from a vertebral hemangioma and just 4% of these are purely extraosseous epidural. Here, we report a successfully treated rare
case of hemorrhagic extraosseous epidural thoracic cavernous