Acute Communicating Hydrocephalus Caused by a Lumbar Intraneural Cavernous Hemangioma in a Child: A Case Report

Abstract Hydrocephalus secondary to a spinal lesion is rare and exceptional in children. Intraneural hemangiomas of the spinal nerve roots typically present with radicular symptoms; their association with hydrocephalus has been reported almost exclusively in adults. We report a previously healthy 5-year-old boy who presented with acute communicating hydrocephalus requiring emergency external ventricular drainage. Cerebrospinal fluid protein was markedly elevated without a cellular reaction, and no intracranial cause was identified. Spinal magnetic resonance imaging revealed an intradural mass at L3–L4 within the filum terminale fibers; resection yielded complete resolution of the hydrocephalus, and histopathology confirmed an intraneural cavernous hemangioma. At 6-year follow-up the child remained well, with no recurrence. To our knowledge, this is the youngest reported case of an intraneural hemangioma of the spinal nerve roots, and the first in any age group in which this lesion presented with acute communicating hydrocephalus. Spinal pathology should be considered in unexplained pediatric communicating hydrocephalus with elevated CSF protein; definitive resection can resolve the hydrocephalus and avoid permanent shunting.