Spinal and paraspinal giant cervical cavernous malformation with postpartum presentation

Case report

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Cavernous malformations (CMs) are found throughout the CNS but are relatively uncommon in the spine. In this report, the authors describe a giant CM with the imaging appearance of an aggressive, invasive, expansive tumor in the cervical spine. The intradural extramedullary portion of the tumor originated from a cervical nerve root; histologically, the lesion was identified as an intraneural CM. Most of the tumor extended into the paraspinal tissues. The tumor was also epidural, intraosseous, and osteolytic and had completely encased cervical nerve roots, peripheral nerves, branches of the brachial plexus, and the vertebral artery on the right side. It became symptomatic during the puerperal period. Gross-total resection was achieved using staged operative procedures, complex dural reconstruction, spinal fixation, and fusion. Clinical, radiographic, and histological details, as well as a discussion of the relevant literature, are provided.

Abbreviations used in this paper:CM = cavernous malformation; GTR = gross-total resection.

Article Information

Address correspondence to: Curtis A. Dickman, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

Please include this information when citing this paper: published online February 24, 2012; DOI: 10.3171/2012.1.SPINE11630.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal (A), parasagittal (B), and axial (C) T2-weighted MR images showing an extensive intradural/extramedullary, epidural, and intraosseous lesion.

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    Intraoperative photographs showing the intradural extramedullary lesion (left) and the epidural extent of the lesion after further dissection (right). Printed with the permission of Barrow Neurological Institute.

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    Photomicrographs of the surgical specimen. Left: Intraneural and perineural dilated vascular spaces of CM. H & E, original magnification × 100. Right: Immunohistochemical CD31 stain highlighting the vascular endothelium of thick- and thin-walled vessels. Original magnification × 200.

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    Postoperative images. Axial T2-weighted MR image (A) confirming GTR. Sagittal CT scans showing anterior (B) and posterior (C) spinal fixation.

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