Spinal radiosurgical treatment for thoracic epidural cavernous hemangioma presenting as radiculomyelopathy: technical case report.

Objective: Image-guided stereotactic radiosurgery (SRS) was applied to a case of spinal epidural cavernous hemangioma in the thoracic spine. This report demonstrates the potential for spinal SRS in treating diseases that have previously required extensive invasive surgery.

Clinical Presentation: A 27-year-old woman with gait disturbance and shoulder pain radiating into the right upper arm and back presented for clinical evaluation. Magnetic resonance imaging revealed an extraforaminal epidural mass compressing the spinal cord at the T1-T2 and T2-T3 levels of the intervertebral foramen. The patient had previously undergone a decompressive laminectomy and open biopsy. Several months after this surgery, her radiculomyelopathy had not improved and appeared to be progressing.

Intervention: Intensity-modulated hypofractionated radiosurgery was performed on the lesion. The patient's radicular pain was remarkably improved within days, and associated neurological symptoms had largely disappeared within a few months. Subsequent follow-up magnetic resonance imaging at 12 and 36 months showed that the tumor mass was greatly reduced. No evidence of any complications associated with irradiation was apparent, and the patient continued to demonstrate a positive prognosis.

Conclusion: A thoracic epidural cavernous hemangioma of proven pathology was successfully treated using state-of-the-art, spinal image-guided SRS. Based on our experience with other types of tumors, we determined that an effective treatment modality for this pathology would be a hypofractionated dose of 32 Gy in 4 fractions. This treatment protocol delivered rapid clinical benefits and long-term tumor control demonstrating the viability of SRS in the treatment of this difficult and rare condition.