Purely extradural cervical cavernous hemangioma presenting with quadriparesis and urinary retention: a case report.

INTRODUCTION AND IMPORTANCE: Cavernous hemangiomas are rarely found in the spinal extradural space, representing only about 4% of all spinal extradural lesions. Purely epidural presentations are exceptionally uncommon. We present a rare case of a purely epidural cavernous hemangioma that presented with acute neurological deterioration following lumbar spine surgery, and we highlight its clinical, radiological, and surgical features. CASE PRESENTATION: A 45-year-old man presented with sudden-onset quadriparesis and urinary retention ten days after lumbar spine surgery performed for presumed disc prolapse. His neurological examination revealed profound weakness in all limbs, sensory loss below C7, absent bladder sensation, and upper motor neuron signs. Magnetic Resonance Imaging (MRI) of the cervical spine showed a homogeneously enhancing epidural mass from C5 to D2, wrapping around the spinal cord and displacing it to the right. A provisional diagnosis of Pott's disease was made, and surgical decompression was planned. Intraoperatively, a reddish, vascular extradural mass was excised using microsurgical techniques without dural invasion. Histopathology confirmed the diagnosis of cavernous hemangioma. Postoperatively, the patient demonstrated significant neurological improvement, with restored bladder function and motor power improving to Medical Research Council (MRC) grade 4-5 in all limbs by 1 month. CLINICAL DISCUSSION: Early surgical intervention, guided by a broad differential that includes vascular malformations, is critical in preventing irreversible neurological deterioration. CONCLUSION: High clinical suspicion and early surgical intervention can lead to favorable neurological outcomes. This case emphasizes the importance of including vascular malformations in the differential diagnosis of spinal extradural masses, especially in patients with atypical postoperative presentations.