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Table of Contents    
LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 244-245

Lumber nerve root cavernous angioma


1 Department of Neurosurgery, State Key Laboratory of Oncology in South , Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
2 Department of Neurosurgery, Liao Ning Tie Fa Coal Group Hospital, Zhen Xing Road, Diao Bing Shan City, Tie Ling city, Liao Ning, China
3 Department of Anesthesiology, State Key Laboratory of Oncology in South , Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Ke Sai
Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou - 510060
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222867

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How to cite this article:
Sun Sx, Zhang J, Sun Jc, Chen Zj, Zhang Xh, Chen Zh, Huang Jx, Jiang Y, Mou Yg, Chen Zp, Sai K. Lumber nerve root cavernous angioma. Neurol India 2018;66:244-5

How to cite this URL:
Sun Sx, Zhang J, Sun Jc, Chen Zj, Zhang Xh, Chen Zh, Huang Jx, Jiang Y, Mou Yg, Chen Zp, Sai K. Lumber nerve root cavernous angioma. Neurol India [serial online] 2018 [cited 2019 Apr 22];66:244-5. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/244/222867




Sir,

A 51-year old man presented with a 5-month history of acute pain bilaterally on the posterolateral aspect of his hip. In his history he revealed that, at an earlier stage, this symptom had persisted for 2 days without radiating to bilateral lower limbs and had got relieved by itself. He had been diagnosed as having protrusion of the lumbar intervertebral disc at a local hospital based on his radiological examination. Approximately 2 months prior to admission, the pain appeared again and progressively radiated to bilateral lower limbs especially on the right side that started severely restricting his movements.

Neurological examination revealed that the Lasegue sign was bilaterally positive, along with mild motor weakness, without tendon hyperreflexia and/or the presence of any pathologic reflex. The magnetic resonance imaging (MRI) of his lumbar (L) spine showed a heterogeneous enhancing, intradural-extramedullary mass at the L2 vertebral level [Figure 1]. A L2 laminectomy and microsurgical excision of the lesion were performed. A dark-red, 20 mm × 12 mm × 10 mm, well-circumscribed mass was identified after opening the tense dura. The mass was densely adherent to the adjacent nerve roots. There was a single thin nerve root that was traversing through the capsule of the lesion. The adhesions of the lesion to the adjacent nerve roots were carefully dissected and the lesion could be removed completely after sacrificing the nerve root [Figure 2]. The surgical specimen was consistent with the diagnosis of a cavernoma [Figure 3]. The postoperative course was uneventful and his symptoms of radiculopathy regressed.
Figure 1: Preoperative MRI of the spine a: T1 sagittal; b: T2 sagittal; c: T2 coronal; and, d: T2 axial images showing a heterogeneous intensity mass at the L2 level

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Figure 2: An intraoperative view showing a dark-red, well-defined mass at the L2 level; and, the L2 nerve root encapsulated within the lesion (the arrow)

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Figure 3: Histological appearance of the surgical specimen showing the closely approximating, irregular vascular channels. (haematoxylin and eosin, ×4)

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Cavernomas can be found in all regions of the central nervous system, especially the cerebral hemisphere; however, they are quite rare in the intradural extramedullary space.[1] Only a few intradural-extramedullary cavernomas (including the present case) have been documented in the entire vertebral canal. The symptomatology of intradural-extramedullary cavernomas depends on their size and location.[2] The most frequent clinical symptoms result from local compression of the nerve roots and/or the spinal cord.[3]

Due to lack of special features of these lesions, it is difficult to preoperatively diagnose them and distinguish them from other intradural-extramedullary tumors such as a neurinoma or a capillary hemangioma. In our case, based on the clinical symptoms and imaging, a neurinoma was considered; however, the postoperative histopathological examination confirmed the typical features of a cavernoma. The histopathological examination serves as the 'gold-standard' modality for diagnosing this lesion; however, the magnetic resonance imaging is also fairly accurate in diagnosing these lesions.[4],[5] A well-defined mass with mixed signal intensity on both T1- and T2-weighted images (due to the presence of mixed subacute and chronic hemorrhage) may be characteristic of a cavernoma.[6] The nonenhanced MRI typically shows a heterogeneous iso-to-hypointense area on both T1- and T2-weighted images without significant contrast enhancement, when compared with the normal intensity signals of the cord.[7],[2],[8] More importantly, the lesion may often be detected to be surrounded by a hypointense ring on T2-weighted images owing to hemosiderin deposition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oppenlander ME, Kalani MY, Dickman CA. Spinal and paraspinal giant cervical cavernous malformation with postpartum presentation. J Neurosurg Spine 2012;16:447-51.  Back to cited text no. 1
    
2.
Cecchi PC, Rizzo P, Faccioli F, Bontempini L, Schwarz A, Bricolo A. Intraneural cavernous malformation of the cauda equina. J Clin Neurosci 2007;14:984-6.  Back to cited text no. 2
    
3.
Nozaki K, Inomoto T, Takagi Y, Hashimoto N. Spinal intradural extramedullary cavernous angioma. Case report. J Neurosurg 2003;99:316-9.  Back to cited text no. 3
    
4.
Petridis AK, Doukas A, Hugo HH, Barth H, Mehdorn HM. A rare case of extradural lumbar nerve root cavernoma. Eur Spine J 2011;20(Suppl 2):S348-S9.  Back to cited text no. 4
    
5.
Santoro A, Piccirilli M, Frati A, Salvati M, Innocenzi G, Ricci G, et al. Intramedullary spinal cord cavernous malformations: Report of ten new cases. Neurosurg Rev 2004;27:93-8.  Back to cited text no. 5
    
6.
Cervoni L, Celli P, Gagliardi FM. Cavernous angioma of the cauda equina: Report of two cases and review of the literature. Neurosurg Rev 1995;18:281-3.  Back to cited text no. 6
    
7.
Er U, Yigitkanli K, Simsek S, Adabag A, Bavbek M. Spinal intradural extramedullary cavernous angioma: Case report and review of the literature. Spinal Cord 2007;45:632-6.  Back to cited text no. 7
    
8.
Crispino M, Vecchioni S, Galli G, Olivetti L. Spinal intradural extramedullary haemangioma: MRI and neurosurgical findings. Acta Neurochir 2005;147:1195-8.  Back to cited text no. 8
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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