T3 infantile hemangioma: first case of a tumor involving epidural, intradural extramedullary, and intradural intramedullary spaces

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Infantile hemangiomas (IHs) are the most common benign neoplasm of the neonatal and newborn period, affecting approximately 5% of infants. However, true IHs presenting in the neuraxis are quite rare with only 15 documented cases in the literature. Management of IH consists of utilizing steroids and immunomodulatory therapies to reduce the size of the tumor and surgery to remove the tumor to decrease symptoms and the risk of bleeding. Operative management of epidural and intradural extramedullary spinal hemangiomas has been described; however, management of intradural intramedullary IH has not been detailed in the literature. In this report, the authors describe the case of a 3-year-old girl who presented with multiple hemangiomas involving the liver, lung, and spine, with one component of the tumor involving the posterior intramedullary aspect of the spinal cord at the level of T3. After medical therapies had failed, the patient underwent endovascular embolization of the spinal hemangioma followed by resection of the tumor. While there is extensive literature on IH throughout many organ systems, only a handful of cases involving the neuraxis have been described. Operative management of refractory IH seems to allow for the reduction of tumor burden and the prevention of hemorrhagic injury.

ABBREVIATIONS IH = infantile hemangioma; PICU = pediatric intensive care unit.

Article Information

Correspondence Saadi Ghatan: Icahn School of Medicine at Mount Sinai, New York, NY. saadi.ghatan@mountsinai.org.

INCLUDE WHEN CITING Published online March 8, 2019; DOI: 10.3171/2018.12.PEDS18554.

J.S. and D.A.N. contributed equally to this paper.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal T2-weighted MR images without contrast showing the dominant mass measuring approximately 2.8 × 2.5 × 4.0 cm.

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    Axial T2-weighted MR images with contrast showing the mass involving the extradural, intradural extramedullary (A), and intradural intramedullary (B) portions of the spinal cord.

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    Right (A) and left (B) T4 arterial injection angiograms displaying supply to the hemangioma preembolization. Postembolization left T3 arterial injection angiograms (C and D) showing a significant reduction in flow to the hemangioma.

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    A: Surgical opening and dissection to the level of the laminae at T1–4. B: Surgical opening after T1–4 laminectomies were performed and visualization of the vascular tumor. C: Dural opening showing the dissection plane between the spinal cord and the tumor. D: Dural opening showing the spinal cord after gross-total resection of the hemangioma. Figure is available in color online only.

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    Histopathological slides and staining specific for IH. A: Arrow indicates vascularity. H & E, original magnification ×20. B: Lobulated arrangement of proliferating endothelial cells with a central lumen. H & E, original magnification ×40. C: Arrow indicates positive staining for CD34. Original magnification ×20. D: Arrow indicates positive staining for GLUT1. Original magnification ×20. Figure is available in color online only.

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