gms | German Medical Science

Objective: Spinal cavernomas are rare vascular lesions in the spinal canal, which may be intramedullary or extramedullary located. They carry a bleeding risk comparable to cerebral aneurysms. Depending on their localization individual treatment strategies for symptomatic and asymptomatic cavernomas apply. The pre- and postoperative courses were analysed to define indications for their operative treatment.

Method: Hospital files, neuroradiological examinations, intraoperative documentations as well as outpatient examinations were analysed. The clinical course was documented for each individual symptom and rates for local recurrences were calculated.

Results: Between 1980 and 2010, 1403 patients with spinal tumors were entered into a spinal cord data base. Among these, 23 patients presented with 24 spinal cavernoma (21 intramedullary, 3 extramedullary). The average age was 46±16 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 reporting a slowly progressing 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, one urinary tract infection and one pneumonia were encountered. There were no recurrences in this series with an average follow-up of 17±23 months.

Conclusions: Acute and severe neurological deficits were restricted to intramedullary lesions and were observed in 2 of 21 patients in this series. Symptomatic cavernomas should be operated. Asymptomatic intramedullay cavernomas should be removed if a gliotic rim has been formed after a hemorrhage and they are located close to the cord surface.