Clinical features and long-term surgical outcomes of pure spinal epidural cavernous hemangioma—report of 23 cases

Background Pure spinal epidural cavernous malformation (CM) is a rare hypervascular disease that is easily misinterpreted as other imaging-similar epidural lesions. The demographic characteristics, therapeutic strategies, and surgical outcomes associated with this vascular entity remains unclear. Methods A retrospective review of patients with pathologically proven, pure epidural CM from 2001 to 2018 was conducted. All data that included clinical manifestations, radiographic features, and treatment modalities were analyzed. Results Twenty-three consecutive patients with an average age of 51.5 ± 8.4 years old (range 38–70 years old) were included; of these, 52.2% were female patients. Clinical manifestation included chronic progressive nerve root disturbance syndrome in 7 patients (30.4%) and myelopathy in 16 patients (69.6%). The CM level was predominately thoracic ( n = 14, 60.9%) or lumbar ( n = 6, 26.1%), with the dorsal epidural space ( n = 14, 60.9%) the most common site. The initial clinical diagnoses were schwannoma ( n = 11, 52.2%), meningioma ( n = 5, 21.7%), angioma ( n = 3, 13.1%), recurrent CMs ( n = 2, 8.7%), and metastatic tumor ( n = 1, 4.3%). Fifteen lesions (65.2%) were isointense on T1-weighted images, and all lesions were hyperintense on T2-weighted images, with homogenously strong enhancement observed in 17 lesions (73.9%). Total resection was achieved in 18 patients (78.3%) and usually resulted in excellent clinical outcomes ( n = 21, 91.3%). No patients experienced recurrence of symptoms, and lesion relapse during follow-up. Conclusion Total surgical removal of epidural CM can usually achieve satisfactory outcomes in patients with a chronic clinical course and should be recommended. Subtotal removal of tumors can also benefit patients, and guaranteed a long recurrent free time after surgery. A good preoperative neurological condition usually leads to good outcomes.