gms | German Medical Science

Objective: A long history of unspecific symptoms is common for intramedullary tumours whereas vascular lesions appear with a sudden onset leading to the correct diagnosis at an early stage. However, treatment is comparable for both entities; surgery remains challenging as it should not worsen neurological functions in this curable disease.

Methods: 31 intramedullary cavernoma out of a series of 269 intramedullary lesions were treated in our department. A retrospective analysis with clinical follow-up of 5 years was carried out. Clinical symptoms were graded according to Cooper and Epstein (CE). Tumours of the craniocervical junction, intramedullary metastases and cauda equina tumours were excluded.

Results: There were 15 females and 16 males with a mean age of 40 yrs. Acute neurological deficits presented with sensory loss (95%), paresis (74%) and gait disturbances (80%). The mean time to diagnosis was 3.5 months (range of 1 to 70 days). A cervical location was noted in 19%, cervicothoracic in 71% and thoracolumbar in 10%. Total resection was achieved in 94 %. Partial resection was carried out in two cases (6%) for fear of a severe loss of function as indicated by intraoperative MEP- and SSEP-monitoring. Routine MRI showed recurrences in two patients in whom asecond surgery had to be carried out. Clinical follow-up in all patients was characterized by worsening in the first postoperative days (CE -1) followed by good to excellent results in 70% of patients with a gain of 1-3 points on the CE scale over a long time.

Conclusions: Compared to intramedullary tumours, clinical history in vascular lesions remains significantly shorter. Time to correct diagnosis is made early and surgery should not be delayed for more than 6 weeks as the bleeding cavitiy has widened the space for dissection and no unfavourable gliotic scaring loss has occurred yet. MEP- and SSEP-monitoring is mandatory in intramedullary surgery but may not be able to prevent worsening of the clinical status immediately after surgery. In the long run, clinical status improves and remains stable, compared to preoperative function, especially in younger patients.