PDF(Pubmed)
Abstract：
BACKGROUND: Cavernous malformation of the cauda equina is a rare neurosurgical condition. We sought to highlight one of these cases and its resultant diagnosis and management. Additionally, to recommend the need for raised clinical suspicion of these rare masses when an extramedullary lesion is noted on imaging.
METHODS: A 42-year-old female presented to our institution with a 9-month history of lower back pain. Her examination findings revealed a loss of right ankle jerk reflex. Magnetic resonance imaging (MRI) of her lumbosacral spine demonstrated an intradural, extramedullary tumor involving the cauda equina, at the L4/L5 level. The main differential diagnosis at this time was an ependymoma. An L4/5 laminectomy and resection of the cauda equina mass was scheduled. Intra-operatively, a mulberry - like mass was noted involving a single nerve root. A gross total resection was performed, with resolution of most of her symptoms. Histopathological diagnosis of a cavernous malformation was ascertained.
CONCLUSIONS: The accurate diagnosis of a cavernous malformation of the cauda equina was only suspected intra-operatively, following gross inspection. Cauda equina masses usually include myxopapillary ependymomas and schwannomas, making this vascular extramedullary lesion low on the possible differentials list. Very few cases have been published in modern literature.
CONCLUSIONS: Cavernous malformations of the cauda equina are an extremely uncommon, benign vascular malformation. These malformations have key characteristics on MRI that can aid its differentiation from other intradural lesions. However, because it is so rare, it does not usually make the list of differentials when considering likely extramedullary lesions.
METHODS: A 42-year-old female presented to our institution with a 9-month history of lower back pain. Her examination findings revealed a loss of right ankle jerk reflex. Magnetic resonance imaging (MRI) of her lumbosacral spine demonstrated an intradural, extramedullary tumor involving the cauda equina, at the L4/L5 level. The main differential diagnosis at this time was an ependymoma. An L4/5 laminectomy and resection of the cauda equina mass was scheduled. Intra-operatively, a mulberry - like mass was noted involving a single nerve root. A gross total resection was performed, with resolution of most of her symptoms. Histopathological diagnosis of a cavernous malformation was ascertained.
CONCLUSIONS: The accurate diagnosis of a cavernous malformation of the cauda equina was only suspected intra-operatively, following gross inspection. Cauda equina masses usually include myxopapillary ependymomas and schwannomas, making this vascular extramedullary lesion low on the possible differentials list. Very few cases have been published in modern literature.
CONCLUSIONS: Cavernous malformations of the cauda equina are an extremely uncommon, benign vascular malformation. These malformations have key characteristics on MRI that can aid its differentiation from other intradural lesions. However, because it is so rare, it does not usually make the list of differentials when considering likely extramedullary lesions.
摘要：
背景：马尾神经海绵状畸形是一种罕见的神经外科疾病。我们试图强调其中一例及其由此产生的诊断和治疗。此外,建议在影像学检查中发现髓外病变时，需要增加对这些罕见肿块的临床怀疑。
方法：一位42岁的女性出现在我们的机构，有9个月的腰痛病史。她的检查结果显示右脚踝抖动反射丧失。她的腰骶椎的磁共振成像（MRI）显示硬膜内，累及马尾的髓外肿瘤,在L4/L5级别。此时的主要鉴别诊断是室管膜瘤。安排了L4/5椎板切除术和马尾肿块切除术。术中,注意到涉及单个神经根的桑树样肿块。进行了全面切除，解决了她的大部分症状.确定了海绵状畸形的组织病理学诊断。
结论：仅在术中怀疑马尾海绵状畸形的准确诊断，粗略检查后。马尾肿块通常包括粘液乳头状室管膜瘤和神经鞘瘤，使这种血管髓外病变在可能的差异列表上较低。很少有案例在现代文学中发表。
结论：马尾海绵状畸形极为罕见，良性血管畸形.这些畸形在MRI上具有关键特征，可以帮助其与其他硬膜内病变区分开。然而,因为它太罕见了，在考虑可能的髓外病变时，它通常不会列出差异。
方法：一位42岁的女性出现在我们的机构，有9个月的腰痛病史。她的检查结果显示右脚踝抖动反射丧失。她的腰骶椎的磁共振成像（MRI）显示硬膜内，累及马尾的髓外肿瘤,在L4/L5级别。此时的主要鉴别诊断是室管膜瘤。安排了L4/5椎板切除术和马尾肿块切除术。术中,注意到涉及单个神经根的桑树样肿块。进行了全面切除，解决了她的大部分症状.确定了海绵状畸形的组织病理学诊断。
结论：仅在术中怀疑马尾海绵状畸形的准确诊断，粗略检查后。马尾肿块通常包括粘液乳头状室管膜瘤和神经鞘瘤，使这种血管髓外病变在可能的差异列表上较低。很少有案例在现代文学中发表。
结论：马尾海绵状畸形极为罕见，良性血管畸形.这些畸形在MRI上具有关键特征，可以帮助其与其他硬膜内病变区分开。然而,因为它太罕见了，在考虑可能的髓外病变时，它通常不会列出差异。
