Intraneural Hemangioma: A Report of Two Cases

Spinal hemangiomas are congenital vascular malformations. Most reports of spinal hemangiomas describe resection via traditional open approaches; however, advances in minimally invasive surgery have led to comparable results. We report on two cases, namely, one nerve root intraneural hemangioma and one nerve root extraforaminal hemangioma, both removed utilizing a minimally invasive technique. Case 1 is about a 61-year-old woman who presented with low back pain with left lower extremity radiculopathy refractory to maximum medical management. This was secondary to an enhancing mass at the right L4-L5 neural foramen (2.4×2.2×2.1 cm) with impingement of the right L4 nerve root. A minimally invasive right L4 nerve sheath mass resection with right-sided L4-L5 transforaminal interbody fusion and pedicle screw fixation was performed. Final pathology was consistent with a benign spindle cell proliferation, indicative of hemangioma. Case 2 is about a 52-year-old man who presented with low back pain with bilateral lower extremity radiculopathy. This was secondary to an enhancing intradural extramedullary lesion (1.4×0.8×1.1 cm) in the spinal canal at the L4 vertebral body with resulting canal stenosis. A minimally invasive L4 intradural spinal mass resection was performed. Final pathology was consistent with intraneural hemangioma.