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NEUROIMAGE
Year : 2014  |  Volume : 62  |  Issue : 3  |  Page : 339-340

Cystic cavernous angioma of the cauda equina mimicking neurenteric cyst


Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Tiantan Hospital, Capital Medical University, Beijing, China

Date of Web Publication18-Jul-2014

Correspondence Address:
Yulun Xu
Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing 100050
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.137031

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How to cite this article:
Yang T, Wu L, Yang C, Xu Y. Cystic cavernous angioma of the cauda equina mimicking neurenteric cyst. Neurol India 2014;62:339-40

How to cite this URL:
Yang T, Wu L, Yang C, Xu Y. Cystic cavernous angioma of the cauda equina mimicking neurenteric cyst. Neurol India [serial online] 2014 [cited 2019 Dec 7];62:339-40. Available from: http://www.neurologyindia.com/text.asp?2014/62/3/339/137031


Cystic cavernous angiomas (CAs) are extremely rare; majority of which are located in supratentorial region. [1] Herein, we report a case of cystic CA, located in the cauda equina, mimicking neurenteric cyst.

A 36-year-old male presented with a 3-month history of intermittent legs pain. Neurological examination was normal. Magnetic resonance imaging (MRI) revealed a cystic lesion involving the cauda equina at L2-3 levels [Figure 1]. Preoperative diagnosis was neurenteric cyst. With the patient in a prone position, a L1-3 laminectomy was performed. Intraoperatively, a reddish, vascular-rich cyst was located in the cauda equina and arisen from attached nerve rootlets. En bloc resection was achieved after cutting off the attached nerve rootlets [Figure 2]. There was significant improvement of pain of both the legs after the surgery. Pathology revealed a CA [Figure 3]. Postoperative MRI showed no recurrence.
Figure 1: Sagittal (a) T1-, Sagittal (b) and axial (c) T2-weighted images showing a cystic lesion with hyperintensity in the cauda equina at the L2-3 levels. Axial (d) and sagittal (e) T1-weighted contrast-enhanced images showed no enhancement of the lesion

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Figure 2: Gross specimen revealing a reddish and vascular-rich cyst with attached nerve rootlets

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Figure 3: Histology sections showing the lesion composed of a large number of thin-walled vascular channels lined by a single layer of epithelial cells. The vascular channel contained red cells. (H and E stain, original magnifi cation ×200)

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Cystic CA is extremely rare. Recurrent hemorrhage from the cyst wall and the osmotic transport of water into the cyst are thought to induce cyst formation. [2] Cystic lesions are a diagnostic challenge and may be diagnosed as neurenteric cysts, especially when intermittent pain is the main symptom. [3] A hypointense hemosiderin ring, which surrounds the lesion is considered to be a typical characteristic of CAs. [2] However, our patient did not exhibit the thin hemosiderin ring. The mechanism of this phenomenon may be more due to rapid removal of blood products outside the blood-brain barrier. [4] Surgeons should keep cystic CAs in the differential diagnosis, because the lesions are highly vascularized and they tend to develop intraoperative hemorrhage. Generally, en bloc resection to avoid severe bleeding should be attempted, and resection of the thin rootlets did not compromise good postoperative recovery. Cystic CA of the cauda equina, although a rare entity, must be added to the differential diagnosis of cystic spinal lesions.

 
  References Top

1.Ohba S, Shimizu K, Shibao S, Nakagawa T, Murakami H. Cystic cavernous angiomas. Neurosurg Rev 2010;33:395-400.  Back to cited text no. 1
    
2.Steiger HJ, Markwalder TM, Reulen HJ. Clinicopathological relations of cerebral cavernous angiomas: Observations in eleven cases. Neurosurgery 1987;21:879-84.  Back to cited text no. 2
    
3.Kim CY, Wang KC, Choe G, Kim HJ, Jung HW, Kim IO, et al. Neurenteric cyst: Its various presentations. Childs Nerv Syst 1999;15:333-41.  Back to cited text no. 3
    
4.Jo BJ, Lee SH, Chung SE, Paeng SS, Kim HS, Yoon SW, et al. Pure epidural cavernous hemangioma of the cervical spine that presented with an acute sensory deficit caused by hemorrhage. Yonsei Med J 2006;47:877-80.  Back to cited text no. 4
    


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