gms | German Medical Science

Objective: Spinal cavernomas are rare vascular lesions in the spinal canal. They may be encountered intramedullary as well as extramedullary or extradurally. Depending on their localization clinical courses differ and require treatment strategies for symptomatic and asymptomatic cavernomas accordingly. The pre- and postoperative courses were analyzed to define indications for their operative treatment.

Methods: Hospital files, neuroradiological examinations, intraoperative documentation as well as outpatient examinations were analyzed. The clinical course was documented for each individual symptom and rates for local recurrences were determined.

Results: Between 1980 and 2010, 1295 spinal tumors were entered into a spinal cord data base. Among these, 23 patients presented with a spinal cavernoma (11 intramedullary, 3 extramedullary and 9 extradurally). The average age was 50 ± 17 years (range: 16–76 years), the clinical history extended over 2 years on average with tremendous variability between 1 week and 10 years. Acute presentations were observed after hemorrhages, which led to severe neurological deficits in 2 patients with intramedullary lesions. About a third of the patients complained mainly about pain with a slowly progressive course. Gait disturbances or motor deficits predominated in 20% of patients each. Intramedullary cavernomas were associated with the most severe neurological deficits compared to other localizations. Twenty patients were operated. All but one intramedullary and one extradural cavernoma were removed completely. The operative technique consisted of shrinking the lesion with bipolar coagulation in order to remove it without undue stress for the spinal cord. It has to be emphasized that the gliotic capsule surrounding intramedullary cavernomas as a result of former hemorrhages should be preserved to avoid significant postoperative neurological deficits – especially if the gliosis contains calcifications. Postoperatively, one wound infection and one cerebrospinal fluid fistula were encountered. There were no recurrences in this series with an average follow up of 28 ± 38 months (maximum 13 years).

Conclusions: Symptomatic cavernomas of the spinal canal should be surgically removed. Cavernomas carry a risk of hemorrhage comparable to that of cerebral aneurysms. Severe neurological deficits are restricted to intramedullary lesions. Asymptomatic intramedullay cavernomas should be removed if they are located close to the cord surface.