Title : Cavernous angioma of the cauda equina: A case report
Abstract:
Introduction: Cavernous angiomas are benign vascular malformations characterized by abnormally dilated vessels that lack interposing neural tissue. The presentation can occur in any region of the central nervous system, but most commonly, supratentorial. This report details a rare infratentorial presentation of a cavernous angioma originating from the cauda equina, a location with 20 documented cases in the literature. Due to its non-specific symptoms, such as low back pain, impotence, and paresthesia, which overlap with those of other conditions, diagnosis can be hampered. Accurate differential diagnosis is crucial for achieving more successful patient diagnoses and outcomes.
Case report:
A 60 year old male with a history of radicular pain for 2 years in right L5 topography, impotence, and paresthesia.
Radiological findings: The diagnosis was made after clinical analyses and a T2-weighted MRI scan of the lumbosacral spine (Levels L1-L2) presenting a predominantly heterogeneous and hyperintense imaging finding (with an intra-axial heterogeneous hypointense halo).
Surgery: Microsurgical resection of the mass was conducted through an L1-L2 laminectomy at Municipal Dr. Mário Gatti’s Hospital (Department of Neurosurgery), Campinas, São Paulo. A mass presented with a rough appearance, brownish color, and firm-elastic consistency measuring 0.4x0.3x0.2 cm was dissected carefully.
Histology and Immunohistochemical Evaluation: Immunohistochemical examination revealed positive staining for CD31 and CD34 markers in the endothelium, diffuse positivity for the S-100 protein marker, and positive staining for the D2-40 podoplanin marker, negative staining for the AE1/AE3, AML, and desmin markers. Histologic examination of the mass revealed the presence of dilated cavernous vessels. Association of immunohistochemical and pathological findings certified the diagnosis of a cavernous angioma.
Post operation: Postoperative MRI images documented the complete resection of the cavernous hemangioma. The patient was followed for 6 months with neurological stabilization and reduced radicular pain sensation.
Discussion: Cavernous angioma is a mulberry-shaped vascular malformation created by anomalous vessels interposed by neural tissue. Characteristic MRI finding, hypointense signal ring around the lesion, is due to haemosiderin deposition and can be used as part of diagnosis. Its non-specific symptoms can overlap with other conditions with higher prevalence, remarking the importance of differential diagnoses. Microsurgical approach is one of the most appropriate techniques that allows complete resection of the tumor with minimal damage towards alongside structures.
Conclusion: Cavernous angiomas are rare benign malformations in the cauda equina that may present symptoms of radicular pain, impotence, and paresthesia; a combination of clinical evaluation, imaging, surgery, and immunohistochemical analysis is crucial for diagnosis and positive outcomes.
Keywords: Cavernous Angioma, Vascular Malformation, Central Nervous System, Neurosurgery.
Audience Take Away Notes:
Attendees will gain insights into the subtleties of clinical symptoms that often elude the diagnosis of an uncommon benign vascular tumor. The correlation between radiological imaging and clinical research contributes to a clearer view of the patient's condition alongside the immunohistochemical findings that substantiate the radiological observations. A potential solution for this type of medical condition will also be presented, highlighting its distinctive qualities.
