PMC4496832_01
Preoperative magnetic resonance images at the level of L2/3 showing an irregularly-shaped, well-defined extradural lesion with paraspinal transforaminal extension that was hypointense on T1-weighted (T1W) (a) and hyperintense on T2W (b) and diffusion-weighted images. (c) Contrast-enhanced T1W images of transverse (d) and coronal sections showed the right L3 nerve root ventrally separated from the homogeneously enhanced tumor (arrow)
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F1
The lesion was isointense on T1-weighted (T1W) and hyperintense on T2W and diffusion-weighted images, with strong homogenous enhancement in a gadolinium (Gd) contrast study [Figure 1]. In the Gd-enhanced images, involvement of the nonenhanced right L3 nerve root in the tumor was identified [Figure 1d and e].
(a) A transverse computed tomography (CT) scan at the level of L2/3 showing a left-sided dumbbell-shaped mass (thick arrow). The posterior wall of the right intervertebral foramen was slightly eroded (thin arrow). (b) A coronal CT scan demonstrating the mildly enlarged right intervertebral foramen and dumbbell-shaped mass (thick arrow)
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F2
Computed tomography (CT) demonstrated mild enlargement of the right neural foramen at L2-3, but there were no remarkable erosive changes of the vertebral body, pedicle or lamina [Figure 2a and b].
A microscopic examination revealed numerous dilated vascular channels of variable sizes lined by a single layer of flattened epithelial cells that was filled with blood elements. The tumor stroma consisted of typical fibrous tissue. The histological findings were characteristic of cavernous hemangioma. (H and E, x100)
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F3
The transverse processes of Th2 and Th3 were identified by fluoroscopy [Figure 3], and were exposed with monopolar cautery. Th2 and Th3 were removed, then a brownish-red, highly vascular mass was identified [Figure 3]. The tumor was highly vascular and bled heavily upon the acquisition of a small biopsy. The capsule was coagulated to control the hemorrhage. The histological examination of the tumor showed it to be a cavernous hemangioma [Figure 3].