Introduction: Purpose: Extramedullary spinal cavernoma is a rare vascular disease. Up to this publication only 23 cases have been reported in the literature. Most have been identified in the low thoracic region and only one in the upper thoracic area. Symptoms can range from mild sensory and motor deficits to severe neurological impairment including bowel/bladder dysfunction.
Methods: Case description: 56-years-old male who presented with 1 year history of progressive lower extremity weakness, occasional allodynia and paresthesias. Patient denied urinary or fecal incontinence. Patient underwent MRI, which demonstrated a T2 heterogeneous mass. Clear intramedullary or extramedullary location could not be established.
Results: Clinical Approach: Initial MRI was performed without IV contrast. Initial differential diagnosis of lesion included ependymoma, meningioma, cavernoma, astrocytoma or focal inflammatory/demyelinating process. Physical exam demonstrated bilateral lower extremity weakness, clonus, and fasciculations.
Clinical findings: Patient underwent surgical resection of the mass. The intraoperative course was marked by easily distinguished borders between the lesion and the spinal cord. Pathology report was consistent with a diagnosis of cavernoma. The patient underwent treatment with laminectomy and segmental fixation through the T1 to T4 segment as well as resection of the lesion. Successful recovery with improvement in the neurologic exam to a near normal motor exam was observed.
Conclusions: We present this rare entity and describe the diagnostic and surgical techniques utilized. Further discussion and review, the most appropriate time for management and furthermore, entertaining this entity in the differential diagnosis is entertained in our discussion.
Patient Care: Our research presents one of the rarest cases of thoracic root pathologies, its recognition and management, therefore extending the field of knowledge regarding our topic, and furthermore improving patient care in future cases.
Learning Objectives: By the conclusion of this session, participants should be able to recognize a rare entity on imagining and its surgical management.