Radiologic and surgical aspects of pure spinal epidural cavernous angiomas- Report on 5 cases and review of the literature

BACKGROUND Cavernous angiomas (CAs) that are localized completely in the spinal epidur al space are uncommon vascular malformations. Although they have increasing ly been reported in the literature in recent years, diagnostic and surgical features are not clearly defined. METHODS We report five patients with pure spinal epidural cavernous angiomas (PSECA s) and review the literature, focusing on their radiologic and surgical cha racteristics. We also compare these tumors with other extra-axial CAs as we ll as with their intra-axial counterparts. RESULTS PSECAs, like all other extra-axial CAs, differ from intraaxial ones on MRI: the hemorrhagic variant is less frequent, hemosiderin rim is rare, the sig nal is different, and contrast enhancement is the rule. They are very simil ar to spinal meningiomas but they differ in their growth pattern and morpho logy, since they infiltrate intervertebral foramina and have an oval shape. In PSECA, intraoperative bleeding is rarely profuse, in contrast to other extra-axial CAs, especially those of the cavernous sinus. CONCLUSIONS On MRI, PSECAs and other extra-axial CAs constitute a homogeneous group sin ce they enhance significantly. At operation, since there is rarely enough b leeding to limit removal, radical excision of PSECAs can be achieved with g ood results. (C) 1999 by Elsevier Science Inc.