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Cauda equina cavernous malformation with nerve fascicle involvement and chronic bowel and urinary urgency: a case report

Year: 2026

Type: article

Abstract: Background: Cavernous malformations of the cauda equina can resemble nerve sheath tumors. Their relationship to functioning nerve fibers complicates surgical decision-making, and preserved motor strength alone may not capture postoperative morbidity. Case description: A 51-year-old woman presented with four years of low back discomfort, numbness of the right fourth and fifth toes, with occasional later numbness of the left fourth and fifth toes, and progressive bowel and urinary urgency without incontinence or weakness. Preoperative MRI demonstrated an approximately 11 × 10 × 15 mm intradural extramedullary nodule at L2, with mildly increased T1 signal, heterogeneous low T2 signal, and heterogeneous enhancement. A cavernous malformation and a neurogenic tumor were considered. At surgery, a gray-purple vascular lesion displaced the cauda equina roots, with a substantial nerve bundle traversing the mass. Most fascicles were separated; a small inseparable portion was coagulated and divided to permit complete excision. Reported motor and somatosensory evoked potentials remained within normal limits; pathology was labeled "cavernous hemangioma." Postoperatively, bilateral hip pain with intermittent leg radiation improved with treatment, although mildly effortful urination was documented on postoperative day 7. At discharge on day 10, strength was grade 5 and no superficial sensory deficit was recorded. Postoperative MRI was obtained approximately four months after surgery. Longer-term autonomic outcomes were not documented. Conclusion: This case highlights the need to consider a cavernous malformation in the differential diagnosis of an L2 intradural mass and to report autonomic and pain outcomes separately from motor preservation after resection involving adherent nerve fascicles.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.2004471

Authors: Shumei Wang, Jifeng Shang

Institutions: Shenzhen University, University of Hong Kong - Shenzhen Hospital

Language: English

Topic: Vascular Malformations Diagnosis and Treatment

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801