Lobular capillary hemangioma of the cauda equina

Abstract

This 56-year-old woman presented with a 1-year history of low-back pain, sciatica, and paresthesias in the right S-1 dermatome. On examination the patient was shown to have a right-sided Lasegue's sign, normal strength, hypalgesia in the right S-1 dermatome, and a slight diminution of the right Achilles tendon reflex. Magnetic resonance imaging revealed a 2-cm intradural enhancing lesion at the level of the L-4 vertebra. Laminectomy of L3-L5 vertebrae was performed, and intradural exploration disclosed a blueberry-appearing tumor that was surrounded by an intense arachnoiditis and attached to the right S-1 nerve root. A cystic collection of cerebrospinal fluid was seen caudal to the tumor. Complete removal required transection of the adherent nerve root fascicles. Histological analyses indicate that the lesion was a lobular capillary hemangioma, which, to the authors' knowledge, appears to be one of the first recorded examples of such a case.