Thoracic Cavernous Spinal Epidural Angiolipomas (SEALs): A Three-Patient Case Report with Excellent Outcomes

Spinal epidural angiolipomas (SEALs) are rare, benign extradural lesions accounting for 0.04 to 1.2% of all spinal axis tumors. They are typically noninfiltrating, located dorsally in the thoracic canal, and present with progressive myelopathy. Histologically, spinal epidural angiolipomas consist of mature adipose tissue interspersed with abnormal vascular channels, which may be capillary or cavernous based on vessel size. Cavernous-type spinal epidural angiolipomas are extremely rare, with only isolated reports in the literature. Surgical decompression with tumor excision is the treatment of choice in symptomatic patients, and diagnosis is confirmed on histopathological examination. We report three patients (two males, one female; age range, 28-60 years) with cavernous-type spinal epidural angiolipoma with varying presentations. MRI demonstrated dorsally located thoracic extradural lesions causing significant cord compression, and in one patient the tumor was extending into the left neural foramina. All patients underwent posterior decompression (open-door laminoplasty, or hemilaminectomy) and piecemeal gross total resection of a well-defined, noninfiltrative, highly vascular epidural mass. Histopathology in all cases confirmed a cavernous variant, composed of congested, thin-walled, dilated vessels admixed with mature adipose tissue. All patients experienced significant postoperative symptomatic improvement, without neurological deterioration or intraoperative neuromonitoring changes. Cavernous-type spinal epidural angiolipomas belong to an extremely rare subtype of spinal epidural angiolipoma that should be considered in the differential diagnosis of enhancing dorsal thoracic extradural lesions. Surgical decompression with gross-total excision offers excellent early neurological recovery in most patients, and histopathological examination remains essential for definitive diagnosis and prognostication.