Extradural spinal cavernous malformation

Extradural spinal cavernous malformations, also known as extradural spinal cavernomas, are rare vascular malformations that occur in the spine. 

This article specifically relates to extradural spinal cavernomas. For a general discussion of spinal cord cavernomas please refer to the article spinal cord cavernous malformation.

Epidemiology

Pure extradural spinal cavernous malformations are rare, representing 4% of spinal extradural mass lesions ^1,2. They have a peak incidence in the 4^th decade without a significant gender bias ³.

Clinical presentation

Common presenting symptoms include myelopathy, radiculopathy, and axial back pain ³. Approximately 10% of cases present with acute onset of symptoms due to hemorrhage or thrombosis ¹.

Pathology

Location

Extradural spinal cavernous malformations are most commonly found in the following locations ¹:

• thoracic spine (64%)

• lumbar spine (20%)

• cervical spine (10%)

• sacrum (6%)

Microscopic appearance

Histological examination of extradural spinal cavernous malformations shows dilated, blood-filled vessels with smooth muscle in the walls, lined by a layer of flattened endothelial cells ⁴.

Radiographic features

CT

May enhance on post-contrast images.

Angiography (DSA)

May demonstrate a vascular blush ⁴.

MRI

• T1: hypo- to isointense

• T2: hyperintense, well-circumscribed convex lesion with hypointense rim

• T1 C+ (Gd): enhances

Treatment and prognosis

Most patients who undergo total or subtotal surgical resection demonstrate improvement or resolution of their acute symptoms ³. Residual neurological deficits after surgery may occur in 38% ³.

Differential diagnosis

• spinal meningioma

• spinal schwannoma

• epidural angiolipoma