{
  "abstract": "Background\n\nIntradural extramedullary (IDEM) tumors of the cauda equina are most often meningiomas, nerve sheath tumors, and myxopapillary ependymomas; purely vascular IDEM lesions are exceptionally rare. Fewer than 30 IDEM hemangiomas have been reported, mostly cavernous or capillary. Epithelioid hemangioma (EH), a benign vascular neoplasm arising in soft tissue and bone, has not previously been reported at the cauda equina.Observations\n\nA 63-year-old male with prior cutaneous melanoma presented with 3 months of progressive left L5-distribution radicular pain. MRI showed a 1.0 × 2.0-cm well-circumscribed IDEM mass at L4-5 with left L5-S1 foraminal stenosis. Under intraoperative ultrasound localization and continuous multimodal neurophysiological monitoring, en bloc gross-total resection was achieved through L4-5 laminectomy. Histopathological analysis revealed a well-circumscribed vascular neoplasm with lobular endothelial architecture and no cytological atypia; immunohistochemical analysis (ERG, CD31, and CD34 positivity; HHV8, inhibin, and melanocytic marker negativity) established the diagnosis of EH. At the 7-week follow-up, gross-total resection was confirmed on postoperative MRI.Lessons\n\nTo the authors' knowledge, this is the first reported intradural EH at any spinal level. Recognition of epithelioid endothelial morphology combined with a comprehensive vascular and melanocytic immunohistochemistry panel is essential for diagnosis and separates EH from more common intradural vascular differentials. https://thejns.org/doi/abs/10.3171/CASE26857.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta.",
    "Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia."
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Al Baker",
      "orcid": "0009-0008-4159-2694"
    },
    {
      "affs": [
        0
      ],
      "name": "Sam Granelli"
    },
    {
      "affs": [
        0
      ],
      "name": "David Baker",
      "orcid": "0000-0001-5458-7896"
    },
    {
      "affs": [
        0
      ],
      "name": "William Woodall"
    },
    {
      "affs": [
        0
      ],
      "name": "Matthew Lee"
    },
    {
      "affs": [
        1
      ],
      "name": "Bryan Morales-Vargas"
    },
    {
      "affs": [
        0
      ],
      "name": "Hyunwoo Do",
      "orcid": "0009-0005-7362-5014"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/93bacbt465fkm.bib",
  "cited_by": 0,
  "doi": "10.3171/case26857",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13726438/?tool=EBI",
  "id": "93bacbt465fkm",
  "issns": [
    "2694-1902"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13726438",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Lesson"
    ],
    [
      "openalex",
      "2746|Vascular Malformations and Hemangiomas"
    ]
  ],
  "openalex": "W7223900924",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13726438/pdf/?tool=EBI",
  "pmcid": "PMC13726438",
  "pmid": "42970789",
  "published": "2026-11-02",
  "publisher": "American Association of Neurological Surgeons",
  "ris": "https://research.draconitic.com/paper/93bacbt465fkm.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13726438",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13726438"
    },
    {
      "first_seen": "2026-11-04T15:20:43Z",
      "native_id": "MED:42970789",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42970789"
    },
    {
      "first_seen": "2026-11-05T12:22:47Z",
      "native_id": "PMC13726438",
      "source": "pmc",
      "url": "https://doi.org/10.3171/case26857"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Vascular Malformations and Hemangiomas",
      "subfield": "surgery"
    }
  ],
  "title": "First reported case of intradural extramedullary epithelioid hemangioma of the cauda equina: resection of an extremely rare vascular neoplasm. Illustrative case",
  "title_text": "First reported case of intradural extramedullary epithelioid hemangioma of the cauda equina: resection of an extremely rare vascular neoplasm. Illustrative case",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:24Z",
  "url": "https://research.draconitic.com/paper/93bacbt465fkm",
  "venue": "Journal of neurosurgery. Case lessons",
  "versions": []
}