Epidural Hemangioma: A Clinical Series of Five Patients and Review of Literature for the Decade

BACKGROUND: Since 1929, only 171 epidural hemangioma cases have been reported. We report five epidural hemangiomas and review cases reported over the past decade in terms of radiological features and clinical findings. METHODS: Among patients operated on for spinal tumors at our hospital between 2009 and 2020, five had epidural hemangiomas. We retrospectively examined patient records and images and reviewed relevant English literature in PubMed from 2009 to 2019. Eighty-seven epidural hemangioma cases were reported in the last 10 years. RESULTS: Among 87 cases, the average age was 49.58 years; 43 and 44 cases were male and female, respectively. The most common lesion level was thoracic (59.8%), while common symptoms were back pain (42.5%); numbness, hypoesthesia, or anesthesia (37.9%); paraparesis (34.5%); and radicular pain (20.7%). On magnetic resonance imaging (MRI), 77.1% showed hypo-isointensity on T1-weighted image (WI), hyperintensity on T2WI, and homogenous enhanced patterns with contrast. Total resection was performed in most cases, with good clinical outcomes. Preoperative embolization was performed in four cases, with good surgical outcomes. The median follow-up duration of postoperative MRI was 16 months, and no case had recurrence. CONCLUSIONS: Epidural hemangiomas are extremely rare and may be difficult to diagnose preoperatively. They should be considered if a dumbbell-shaped or epidural hypervascular lesion is noted. The treatment of choice for epidural hemangioma is total resection, with most cases having good clinical outcomes. Preoperative embolization may be useful for reducing bleeding. Although there were almost no recurrences after resection, careful follow-up for longer periods is required.