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

  • View in gallery

    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.

  • View in gallery

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



Acciarri NPadovani RPozzati EGaist GManetto V: Spinal cavernous angioma: a rare cause of subarachnoid hemorrhage. Surg Neurol 37:4534561992


Aoyagi NKojima KKasai H: Review of spinal epidural cavernous hemangioma. Neurol Med Chir (Tokyo) 43:4714762003


Carlier REngerand SLamer SVallee CBussel BPolivka M: Foraminal epidural extra osseous cavernous hemangioma of the cervical spine: a case report. Spine (Phila Pa 1976) 25:6296312000


Caruso GGalarza MBorghesi IPozzati EVitale M: Acute presentation of spinal epidural cavernous angiomas: case report. Neurosurgery 60:E575E5762007


Cecchi PCRizzo PFaccioli FBontempini LSchwarz ABricolo A: Intraneural cavernous malformation of the cauda equina. J Clin Neurosci 14:9849862007


Clatterbuck RECohen BGailloud PMurphy KRigamonti D: Vertebral hemangiomas associated with familial cerebral cavernous malformation: segmental disease expression. Case report. J Neurosurg 97:2 Suppl2272302002


D'Andrea GRamundo OETrillò GRoperto RIsidori AFerrante L: Dorsal foramenal extraosseous epidural cavernous hemangioma. Neurosurg Rev 26:2922962003


Hatiboglu MAIplikcioglu ACOzcan D: Epidural spinal cavernous hemangioma. Neurol Med Chir (Tokyo) 46:4554582006


Hillman JBynke O: Solitary extradural cavernous hemangiomas in the spinal canal. Report of five cases. Surg Neurol 36:19241991


Kaya AHUlus ABayri YTopal AGun SKandemir B: There are no estrogen and progesterone receptors in cerebral cavernomas: a preliminary immunohistochemical study. Surg Neurol 72:2632652009


Kivelev JRamsey CNDashti RPorras MTyyninen OHernesniemi J: Cervical intradural extramedullary cavernoma presenting with isolated intramedullary hemorrhage. Case report. J Neurosurg Spine 8:88912008


Minh NH: Cervicothoracic spinal epidural cavernous hemangioma: case report and review of the literature. Surg Neurol 64:83852005


Mitha APTurner JDAbla AAVishteh AGSpetzler RF: Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience. Clinical article. J Neurosurg Spine 14:6056112011


Morioka TNakagaki HMatsushima THasuo K: Dumbbell-shaped spinal epidural cavernous angioma. Surg Neurol 25:1421441986


Nozaki KInomoto TTakagi YHashimoto N: Spinal intradural extramedullary cavernous angioma. Case report. J Neurosurg 99:3 Suppl3163192003


Padovani RPoppi MPozzati ETognetti FQuerzola C: Spinal epidural hemangiomas. Spine (Phila Pa 1976) 6:3363401981


Padovani RTognetti FProietti DPozzati EServadei F: Extrathecal cavernous hemangioma. Surg Neurol 18:4634651982


Rachinger JBuslei REngelhorn TDoerfler AStrauss C: Intradural-extramedullary cavernous hemangioma of the left motor root C7—case report and update of the literature. Zentralbl Neurochir 67:1441482006


Rao GPBhaskar GHemaratnan ASrinivas TV: Spinal intradural extramedullary cavernous angiomas: report of four cases and review of the literature. Br J Neurosurg 11:2282321997


Safavi-Abbasi SFeiz-Erfan ISpetzler RFKim LDogan SPorter RW: Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature. Neurosurg Focus 21:1e122006


Sarikaya-Seiwert SGierga KWessalowski RSteiger HJHänggi D: Solitary spinal epidural cavernous angiomas in children presenting with acute neurological symptoms caused by hemorrhage. Report of 2 cases. J Neurosurg Pediatr 5:89932010


Shapiro GSMillett PJDiCarlo EFMintz DNGamache FWRawlins BA: Spinal epidural hemangioma related to pregnancy. Skeletal Radiol 30:2902942001


Spetzler RFDetwiler PWRiina HAPorter RW: Modified classification of spinal cord vascular lesions. J Neurosurg 96:2 Suppl1451562002


Voelker JLStewart DHSchochet SS Jr: Giant intracranial and extracranial cavernous malformation. Case report. J Neurosurg 89:4654691998


Zevgaridis DBüttner AWeis SHamburger CReulen HJ: Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature. J Neurosurg 88:9039081998




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