Primary spinal extradural cavernous haemangiomas: a report of three cases and review of literature.

Introduction: Primary spinal extradural cavernous haemangiomas (ECHs) are histologically benign but can behave aggressively by eroding the spine or compress neural elements. They are rare and can be mis-interpreted for other more common epidural lesions. Surgery is the gold standard in management. In this report, we highlight the diagnostic and intraoperative technical considerations needed to achieve a good clinical outcome. In addition, a comprehensive literature review was conducted.

Results: We report three cases (two males and one female) with an average age of 40 years. Two patients presented with radiculopathy and one patient presented with thoracic myelo-radiculopathy. The ECH location was cervico-thoracic in two patients and sacral in one. Pre-operative working radiological diagnosis of the cervico-thoracic lesion with homogenous contrast enhancement was haemangioma, while the other two were schwannoma. Two patients underwent pre-operative CT-guided biopsy, and the diagnosis was confirmed in one. Two patients underwent pre-operative catheter angiography, and embolisation was performed in one. All three patients had complete tumour resection with no recurrence on follow-up imaging (mean 33 months). The histology in all three cases confirmed cavernous haemangioma.

Conclusion: Although a rare entity, spinal ECH should be considered in the differential diagnosis of large extradural lesions that extend through the neural foramina. From a surgical viewpoint, wide bony exposure facilitates complete removal of these benign tumours and is associated with better outcomes. Whilst not mandatory, en bloc excisions can help reduce significant blood loss.