Thoracic spinal epidural angiolipoma presenting with progressive paraparesis in an elderly patient

Spinal epidural angiolipomas (SEALs) are rare, benign tumors composed of mature adipocytes and abnormal vasculature, representing only 0.04-1.2% of spinal tumors. Predominantly located in the thoracic epidural space, they often cause progressive neurological deficits due to spinal cord compression, though acute deterioration may occur from hemorrhage or thrombosis. Misdiagnosis is common, and evidence-based management remains limited.

a 74-year-old woman presented with a 3-month history of progressive paraparesis, gait instability, and left-sided hyperreflexia. Spinal magnetic resonance ımaging revealed an 11 cm posterior epidural mass extending from T3 to T7, causing severe cord compression with myelopathic signal changes. The patient underwent T4-T6 laminectomy with gross total resection of the highly vascular mass. Histopathology confirmed the diagnosis of SEAL. Postoperatively, her symptoms improved, and she was discharged without complications.

This case highlights the importance of recognizing SEALs in differential diagnoses of spinal cord compression, emphasizing meticulous surgical excision for favorable outcomes. A literature review underscores the need for standardized management guidelines for these rare lesions.