Intradural extramedullary venous hemangioma mimicking meningioma: a case report and literature review

Abstract Background Intradural extramedullary hemangiomas of the spinal canal are rare, and the venous subtype is particularly uncommon. Their imaging appearance can overlap with more frequent intradural extramedullary tumors, which increases the risk of misdiagnosis. This case report aims to describe an intradural extramedullary venous hemangioma that mimicked meningioma on MRI and to highlight key surgical considerations. Case presentation A 49-year-old man presented with a five-month history of progressive numbness, radicular pain, and weakness in the left lower limb, which progressed to gait disturbance. Neurological examination revealed hypoesthesia over the lateral left leg and dorsum of the foot, with motor weakness of the extensor hallucis longus and hamstring muscles (MRC grade 3/5). Magnetic resonance imaging demonstrated an 11 × 9 mm intradural extramedullary lesion at T12/L1 that appeared slightly hyperintense on T1-weighted images, isointense on T2-weighted images, and showed mild homogeneous enhancement with a subtle dural tail sign, suggesting a diagnosis of meningioma, following which the patient underwent posterior T12 total laminectomy with lamina replantation and gross total resection was achieved without nerve root sacrifice. Microsurgical excision revealed a dark red, mulberry-like vascular mass densely adherent to the spinal cord and cauda equina nerve roots. Histopathological analysis demonstrated proliferated vascular channels of variable lumen size, positive endothelial staining for ERG, and a Ki-67 index of approximately 2%, confirming venous hemangioma. Postoperatively, the patient experienced immediate pain relief and progressive neurological improvement. At one-year follow-up, motor strength had fully recovered, with only mild residual numbness and no radiological evidence of recurrence. Conclusion This case illustrates a rare intradural extramedullary venous hemangioma that radiologically mimicked meningioma. Complete microsurgical resection provided promising neurological recovery and highlights the importance of considering vascular tumors in the differential diagnosis of intradural spinal lesions.