EPIDURAL SPINAL CAVERNOUS HEMANGIOMA

Study Design. Five cases of epidural spinal cavernous hemangioma submi tted to magnetic resonance imaging and surgery were reviewed. Objectiv e. To correlate different magnetic resonance imaging appearances of ep idural spinal cavernous hemangioma with histologic findings. Summary o f Background Data. Cavernous hemangioma is an uncommon vascular malfor mation that may occur anywhere in the central nervous system. Purely e pidural lesions are very rare. Accurate correlation between magnetic r esonance imaging appearances and histologic findings have not been rep orted in the literature. Methods. Five cases of epidural spinal cavern ous hemangioma that had undergone magnetic resonance imaging evaluatio n followed by microsurgical removal, were retrospectively reviewed. Co nventional spin-echo T1-, proton density- and T2-weighted magnetic res onance images were obtained in all cases, and gadolinium was used in a ll but one. Two cases have also been evaluated with computed tomograph y. Results. In two cases, magnetic resonance imaging showed mixed low- and high-signal intensity components in all sequences and pathologic e xamination showed degenerative phenomena and hemosiderin pigments. In the remaining three cases, magnetic resonance imaging showed low- or i ntermediate-signal intensity on T1-weighted and high-signal intensity on proton density- and T2-weighted images. In those cases, pathologic examination showed an absence of degenerative phenomena and no signs o f hemorrhage. All patients underwent surgery by laminectomy and micros urgical resection. In all, significant improvement was obtained. Concl usions. Epidural spinal cavernous hemangioma has a different magnetic resonance imaging appearance probably because of the presence or absen ce of the degenerative phenomena and hemosiderin pigments. As in cereb ral locations, mixed signal intensity in all sequences on magnetic res onance images might be indicative of cavernous hemangioma. Presumptive preoperative diagnosis of the lesion may render the surgical approach less invasive.