Purely extraosseous epidural cavernous hemangioma: a rare diagnostic entity. Illustrative case

Extraosseous epidural cavernous hemangiomas are rare spinal lesions. While often asymptomatic, they can present in patients with myelopathy-/radiculopathy-like symptoms. These lesions can be caused by venous pooling secondary to negative pressure within the intrathoracic cavity. Diagnosis is often challenging and largely relies on radiographic imaging, where lesions are commonly found in the thoracic spine region and present as a homogeneous contrast-enhancing signal intensity on MRI T1-weighted sequences and appear as hyperintense on T2-weighted sequences. Although usually indolent, these lesions can cause compression or can rupture, causing hyperacute neurological decline.

The authors describe the case of a 77-year-old woman with a history of breast cancer and melanoma presenting with progressive low back pain and new urinary incontinence. Initial lumbar MRI was unremarkable, but thoracic MRI revealed a 2-cm dorsal epidural lesion at the T7 level. Minimally invasive laminectomy achieved gross-total resection and pathological analysis confirmed a cavernous hemangioma. On the 1-month follow-up, the patient reported complete remediation of symptoms.

This case highlights the importance of including extraosseous epidural cavernous hemangioma in the differential diagnosis for spinal lesions, even in patients with nonspecific symptoms. Early recognition requires considering spinal imaging beyond the symptomatic region. Prompt resection is recommended to prevent worsening symptomatology and acute neurological decline. https://thejns.org/doi/10.3171/CASE25637.