gms | German Medical Science

Objective: Due to magnetic resonance imaging cavernous malformations (CMs) of the spinal cord are detected with increasing frequency. They account for approximately 5% of all intraspinal lesions. Experience with the treatment of these lesions and follow-up is very limited. The purpose of this study was to analyze our management concept in terms of surgical technique and clinical outcome for these benign but clinically progressive lesions.

Methods: A retrospective chart review and video analysis was performed in 13 patients with histologically diagnosed CMs treated in an 8-year period (1998-10/2006). All patients underwent preoperative magnetic resonance (MR) imaging studies. Patients were treated with a hemilaminectomy (n=11), laminenctomy (n=1), laminoplasty (n=1) and microsurgical resection assisted by somatosensory evoked potentials and ultrasonography. The pre- and postoperative neurological findings were classified using the Frankel scale.

Results: Eight females and five males (mean age 43,5 yrs) with intramedullary CMs could be diagnosed by MRI. The imaging findings were diagnostic for CMs with a characteristic imaging pattern. In 61,5% the CMs were localized in the cervical spinal cord and in 38,5% in the thoracic spinal segments. The microsurgical strategy was to localize the intramedullary CMs and to dissect the lesion by interrupting the tiny vessels entering the CM. Total removal was achieved in all patients as documented in the follow-up MRI. The average follow-up period was 11,8 months. The neurological status of 10 patients improved after surgery, in 3 individuals,the clinical features were unchanged (Frankel D: n=7; Frankel E: n=6). Two patients suffered from persisting painful neuropathy after surgery. One patient had a thrombosis and one patient a wound infection.

Conclusions: The available data suggest that surgical management of intramedullary cavernomas should attempt complete extirpation. Total removal of these lesions supported by intraoperative neuromonitoring and ultrasonography tend to halt progression of symptoms with an acceptable procedure-related morbidity. These spinal lesions should be considered for early surgery, before repeated hemorrhage or enlargement can occur.