Surgical treatment to resect giant intraspinal epidural cavernous hemangioma of Cobb syndrome: illustrative case.

backgroundCobb syndrome is a rare nonfamilial neurocutaneous syndrome. It is characterized by vascular malformations of the skin, spine, spinal membrane, and spinal cord of the same body segment. However, epidural cavernous hemangioma as the main manifestation of intravertebral canal space is extremely rare, and the treatment is often more complex and difficult. Only a few cases have been reported. OBSERVATIONS: Here, the author reported a case of Cobb syndrome with a large intraspinal cavernous hemangioma in a 23-year-old man with paresthesia and paralysis of both lower limbs. The authors highlight the case presentation, operative technique, and postoperative course. Following surgery, there were no immediate surgical complications, and the patient noted clinical improvement in neurological function. LESSONS: This report presents a case of Cobb syndrome involving a large spinal epidural cavernous hemangioma, with the aim to enhance the understanding of this rare condition. Although delayed treatment still yielded favorable recovery in this case, early MRI screening (in patients with cutaneous hemangiomas and neurological symptoms) could prevent irreversible spinal cord damage. An ultrasonic bone cutter should be considered the instrument of choice for epidural hypervascular lesions, particularly in reoperations or high-bleeding-risk scenarios, due to its hemostatic mechanical effect, which minimizes intraoperative risks (dural injury or major hemorrhage). https://thejns.org/doi/10.3171/CASE24838.