What Is a Spinal Hemangioma?

Spinal cavernous hemangioma is relatively rare, and there are not many reports at home and abroad. With the wide application of magnetic resonance examination, its detection rate has an increasing trend. Spinal cavernous hemangioma is currently considered to be a type of occult spinal vascular malformation, accounting for 5% to 12% of spinal vascular diseases, which can occur in different parts of the spinal cord. Its origin and mechanism are the same as intracranial cavernous hemangioma, which is a congenital, non-hemangioma developmental abnormality of the spinal cord blood vessels. According to the occurrence site, it is divided into intramedullary type, intradural extramedullary type, extradural type, and vertebral body type. Among them, the intramedullary type is the most common and has the greatest impact on the nervous system.

Basic Information

Visiting department

Neurology, vascular surgery

Multiple groups

Young people

Common locations

spinal cord

Common causes

Common symptoms

Intramedullary type is limb dysfunction, movement, and sphincter dysfunction, with back pain and limb pain during bleeding; recurrent neurological dysfunction occurs during disease progression

Causes of spinal cavernous hemangioma

Spinal cavernous hemangioma is currently considered to be a type of occult spinal vascular malformation, accounting for 5% to 12% of spinal vascular diseases, which can occur in different parts of the spinal cord.

Clinical manifestations of spinal cavernous hemangioma

The average age of patients with this disease is 35 years. Patients may have manifestations of acute neurological dysfunction, most of which are related to subarachnoid hemorrhage. Due to the acute or chronic dilation of blood vessels, when the volume reaches a certain level, blood can be emitted due to rupture. Progressive neurological dysfunction can also occur, and symptoms of neurological dysfunction can persist for several days due to recurrent bleeding. Take the most common intramedullary spinal cavernous hemangioma as an example: its main manifestations are limb sensory, motor and sphincter dysfunction, and bleeding is often accompanied by back and limb pain. Such as hemangiomas protruding from the surface of the spinal cord can cause subarachnoid hemorrhage. According to the progress of the disease, the clinical manifestations of intramedullary cavernous hemangioma can be as follows: Intermittent, recurrent neurological dysfunction occurs due to repeated microbleeds or malformed intravascular thrombosis, and nerve function has recovered to varying degrees during the episode. This is a major feature of cavernous hemangioma. Due to the thickening of the vascular space due to bleeding, the volume of cavernous hemangioma increases progressively, and chronic progressive neurological decline occurs. Intramedullary hematoma due to bleeding, the patient's condition progresses rapidly, and neurological function rapidly decreases, which can cause severe consequences such as paraplegia. Asymptomatic and accidental discovery.

Cavernous Hemangioma of the Spinal Cord

Because cavernous hemangioma has no complete blood supply artery and drainage vein, there is no abnormal staining in spinal angiography, which can be distinguished from spinal vascular malformations. MRI is specific for the diagnosis of spinal cavernous hemangioma, and can show changes in signal of bleeding components at different periods. The lesion is mainly manifested by mixed signals of T ₁ and T ₂ weighted images. The hemosiderin deposits around the lesion can be seen to form a low signal band with a long T _{1 and a} short T ₂ . ; Generally no vascular flow emptying, this is the specific manifestation of MRI diagnosis of spinal cavernous hemangioma.

Spinal cavernous hemangioma diagnosis

Spinal cavernous hemangioma should be considered if the following characteristics appear: Have typical MRI manifestations, which can show the signal changes of bleeding components at various stages; Spinal angiography is normal; Clinically, sensory, motor, sphincter dysfunction and trunk back pain More common, with intermittent, recurrent features; patients with family history or complicated with cerebral cavernous hemangioma.

Spinal cavernous hemangioma complications

And issued blood, neurological dysfunction may occur.

Spinal Cavernous Hemangioma Treatment

No special treatment is required for cavernous vascular malformations without spinal cord symptoms. Symptomatic and recurrent intramedullary cavernous hemangiomas should be actively operated, and surgery should not be delayed due to temporary relief of symptoms, resulting in rebleeding and affecting curative effects. Surgery should be performed under a microscope, and the operation must be gentle and accurate to avoid rough pulling and squeezing of the spinal cord, so as to avoid damage to the already fragile spinal cord. Attention should be paid during operation: Normally, blue-violet or purple-brown abnormal areas can be seen on the surface of the spinal cord with clear boundaries. The spinal cord membrane is cut at the lesion. In patients with reactive glial hyperplasia of surrounding tissues due to repeated bleeding, a thin layer of glial interface is often formed between hemangiomas and normal spinal cord tissue. Strictly following this interface under the microscope and separating close to the lesion can prevent spinal cord injury. Use a wet gelatin sponge to stop bleeding as much as possible, and use weak bipolar electrocoagulation when it is not effective. Each electrocoagulation time should be short, and rinse with physiological saline at any time to prevent the heat generated during electrocoagulation from spreading. Injury to the spinal cord. The shape of the lesion is often irregular or lobulated. Care should be taken not to leave the lesion, otherwise it is easy to relapse. The entire operation is performed under electrophysiological monitoring to prevent accidental injury to the spinal cord during the operation.

Spinal cavernous hemangioma is a low-pressure vascular malformation, which is easy to be completely removed, and the incidence of surgical complications is low. Incomplete small drainage veins are sometimes seen around the lesion during the operation and need to be carefully removed. It should be emphasized that if the boundary between the hemangioma and the spinal cord is not clear, it should not be removed blindly, so as not to damage the normal spinal cord. After resection of the hemangioma, the tumor bed should be carefully checked to prevent recurrence. For hemangiomas not visible on the surface of the spinal cord, a midline incision can be taken to remove the lesion. At present, there are few reports on the efficacy of stereotactic radiosurgery in the treatment of intramedullary cavernous hemangioma, and surgical resection is still recognized as a precise and effective treatment.