Background:Spinal dumbbell-shaped epidural cavous malformation (CM) is a rare, hypervascular entity frequently misdiagnosed for other lesions, leading to unexpected intraoperative bleeding and suboptimal resection. Our study aims to elucidate the demographics, management strategy, and outcome of this vascular disease.Methods:Retrospective review of patients seen in Beijing Tiantan Hospital with symptomatic dumbbell-shaped epidural CM from 2008 to 2013. All lesions were pathologically confirmed after resection. The clinical manifestations, radiographic features, and treatment modalities of these cases were analyzed.Results:We included 9 consecutive patients. Average age was 58 ± 12 years (range:34-79 years), with 66.7％male. Locations of the CMs were:thoracic (n=7, 77.8％), cervical (n=1, 11.1％), and cervicothoracic junction (n=1, 11.1％). Only one case presented with acute manifestations while others experienced chronic progressive spinal cord symptoms. The initial clinical diagnoses were:schwannoma (n=6, 66.7％), cavous hemangioma (CM) (n=1, 11. 1％), meningioma (n=1, 11.1％), and angioma (n=1, 11.1％). Total resection was achieved in six patients (66.7％), and partial resection in the other three patients (33.3％). Average intraoperative blood loss was 400 ± 300 ml (range:100-1000 ml). During an average follow-up of 71 ± 21 months (range:29-94 months), excellent outcome was achieved in seven cases (77.8％), one partially improved (11.1％), and one deteriorated (11.1％). No patients experienced recurrence of symptoms.Conclusions:Spinal dumbbell-shaped epidural CM is a benign vascular malformation that should be differentiated from other dumbbell-shaped lesions. Accurate preoperative diagnose is challenging as no specific radiographic marker has been established. Total surgical resection should be recommended.