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오선규,배채완,안재성,임승철 대한척추신경외과학회 2010 Neurospine Vol.7 No.2
We present a rare case of an intradural ventral arteriovenous fistula(AVF) mimicking an intramedullary ependymoma. A 46‐year‐old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole‐spine magnetic resonance imaging(MRI) scan revealed a 0.5‐cm‐sized intramedullary lesion of high signal with a dark signal rim on a T2‐weighted image at the T9 level. The T1‐weighted MRI after contrast enhancement revealed a nodular and rim‐like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened. Spinal angiogram demonstrated a small intradural ventral AVF with a single feeding artery from the upper limb of the radiculomedullary artery at the T9 level on the left side. Endovascular embolization was performed but failed due to unex- pected vasospasm resulting in paraplegia. Finally, the patient underwent re‐exploration and surgical ligation of the AVF. The postoperative angiogram demonstrated complete obliteration of the fistula. Most spinal AVFs are found in elderly patients, as spinal degenerative diseases or neoplasms. Although it is a rare disease, clinicians should be aware of the occurrence of spinal AVFs, because their misdiagnoses can result in progressively disa- bling neurologic conditions. Thus, clinicians must attempt to correctly diagnose spinal AVFs at the first examination. We present a rare case of an intradural ventral arteriovenous fistula(AVF) mimicking an intramedullary ependymoma. A 46‐year‐old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole‐spine magnetic resonance imaging(MRI) scan revealed a 0.5‐cm‐sized intramedullary lesion of high signal with a dark signal rim on a T2‐weighted image at the T9 level. The T1‐weighted MRI after contrast enhancement revealed a nodular and rim‐like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened. Spinal angiogram demonstrated a small intradural ventral AVF with a single feeding artery from the upper limb of the radiculomedullary artery at the T9 level on the left side. Endovascular embolization was performed but failed due to unex- pected vasospasm resulting in paraplegia. Finally, the patient underwent re‐exploration and surgical ligation of the AVF. The postoperative angiogram demonstrated complete obliteration of the fistula. Most spinal AVFs are found in elderly patients, as spinal degenerative diseases or neoplasms. Although it is a rare disease, clinicians should be aware of the occurrence of spinal AVFs, because their misdiagnoses can result in progressively disa- bling neurologic conditions. Thus, clinicians must attempt to correctly diagnose spinal AVFs at the first examination.
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Epidural Cavernous Hemangioma with Foraminal Extension
하진경,배채완,강신광,임승철 대한척추신경외과학회 2011 Neurospine Vol.8 No.3
The increased use of magnetic resonance imaging (MRI) has increased the frequency of diagnosis of cavernous hemangioma, but its presentation of an epidural lesion with foraminal extension without intramedullary involvement is very rare. We describe a 31-year-old woman admitted to our department with pain in the left side of her neck and shoulder. Gadolinium enhanced cervical MRI revealed a brightly enhanced, extradural mass (1×1×2 cm sized) with widened neural foramen; after surgical excision, it was histologically confirmed as a cavernous hemangioma. Postoperatively, the patient has no neurological deficit or specific complication. Although this lesion mimicked an epidural- neurogenic tumor, its enhancement pattern indicated a cavernous hemangioma. Accurate preoperative diagnosis is necessary for treatment planning. Cavernous hemangioma must be included in the differential diagnosis of a brightly enhanced, extradural tumors.
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