gms | German Medical Science

Objective: We demonstrate clinical features, therapy and outcome of patients with symptomatic spinal cavernous malformations (CM).

Methods: We retrospectively reviewed the charts of all patients, who underwent microsurgical treatment of symptomatic spinal CM, diagnosed by MRI, during the last decade in our department (n=14). The neurofunctional impairments at time of admission, discharge and follow-up examination were classified using the Frankel scale and the McCormick classification. The surgical approach to the spine was hemilaminectomy (n=6), laminectomy (n=4), laminoplasty (n=2) and interlaminar fenestration (n=2). Surgical procedure was done under electrophysiological monitoring with somatosensory evoked potentials.

Results: We analyzed the data of 14 patients (11 female, 3 male) with symptomatic spinal CM in a range of 16 to 77 years (mean age 47.8 years). CM was located intramedullary in 9 cases, affecting the cervical spine in 5 and the thoracic spine in 4 cases. Two CM were located within the conus medullaris and additional 2 CM extradurally. One CM was located in the 12^th vertebral body. Simultaneous occurrence of cerebral CM was observed in 3 patients. Twelve patients had slow progressive clinical symptoms and two patients presented with acute neurological deterioration. The most frequent clinical symptom was sensory disturbance in varying manifestation and expansion in 9 patients, followed by disturbances of gait and coordination with balance difficulties in 8 patients. Neck, back and leg pain were observed in 7 patients. Positive pyramidal signs and hyperreflexia occurred in 4 patients. Postoperative re-bleeding with necessity of surgical revision occurred in 2 patients. Postoperatively, the clinical symptoms improved rapidly in 7 patients (50%). The remaining seven patients presented new non pre-existing complaints, which improved gradually with a favourable outcome at the last follow-up examination in six cases.

Conclusions: Spinal CMs are increasingly diagnosed early in patients presenting with varying spinal cord symptoms and pain syndromes. Microsurgical treatment depending on the operative accessibility under electrophysiological monitoring is justified to prevent severe neurofunctional deterioration. Although some patients deteriorate after surgery, the symptoms are rapidly declining with a favourable outcome in the majority of these cases.