吻合血管瘤是主要发生于泌尿生殖道和椎旁软组织的良性血管肿瘤。目前尚无脊髓硬膜外腔发生吻合血管瘤的病例报道；因此，他们的临床和放射学表现仍不清楚。 一名 55 岁男性出现进行性背痛以及双下肢运动和感觉障碍。磁共振成像 (MRI) 显示 T4-6 水平的硬膜外病变通过左侧 T5-6 椎间孔延伸至脊柱外区域。轴向 MRI 显示肿瘤环绕脊髓，椎管内有尖锐的角状末端。患者接受了 T4-6 椎板切除术和左侧 T5-6 椎间孔切开术的完整肿瘤切除术。组织病理学诊断为吻合血管瘤，表现为毛细血管与平头内皮细胞的吻合增生。术后4个月，症状改善，肿瘤得到控制，无需辅助治疗。尽管罕见，但脊髓硬膜外腔可发生吻合血管瘤。从放射学上看，肿瘤显示出环绕脊髓的角状突起，这可以作为诊断线索。吻合血管瘤应包括在脊柱硬膜外肿瘤的鉴别诊断中，特别是当存在特征性的角状突出时。 https://thejns.org/doi/10.3171/CASE24265。

Anastomosing hemangiomas are benign vascular neoplasms occurring mainly in the genitourinary tract and paraspinal soft tissues. There have been no reported cases of anastomosing hemangiomas occurring in the spinal epidural space; therefore, their clinical and radiological presentations remain unclear.A 55-year-old man presented with progressive back pain and motor and sensory disturbances in both lower extremities. Magnetic resonance imaging (MRI) revealed an extradural lesion at the T4-6 level that extended into the extraspinal region through the left T5-6 intervertebral foramen. Axial MRI revealed that the tumor encircled the spinal cord, with sharp horn-like ends in the intraspinal canal. The patient underwent complete tumor resection with T4-6 laminectomy and left T5-6 foraminotomy. The histopathological diagnosis was an anastomo-sing hemangioma exhibiting anastomosing proliferation of capillary vessels with hobnailed endothelial cells. His symptoms improved, and tumor control was achieved 4 months after surgery without adjuvant therapy.Although rare, anastomosing hemangiomas can occur in the spinal epidural space. Radiologically, the tumors show horn-like projections encircling the spinal cord, which can be diagnostic cues. Anastomosing hemangiomas should be included in the differential diagnosis of spinal epidural tumors, especially when characteristic horn-like projections are present. https://thejns.org/doi/10.3171/CASE24265.