gms | German Medical Science

Objective: Spinal cavernomas (SC) depict a rare entity in spinal lesions, but causal surgical treatment and definite cure is reachable. Operative strategies are very demanding due to the vulnerability of the spinal cord with possibly permanent neurological deterioration caused by the approach itself. In the presented study, clinical presentation, microsurgical strategies as well as postoperative outcome are displayed in a cohort of 48 cases.

Method: 48 intramedullary SC out of a series of 400 patients with spinal cord lesions (12%) were identified and medical records analysed. A retrospective analysis was performed focussing on anatomical location, surgical approach, preoperative patient history, direct postoperative outcome (assessed by the ASIA impairment scale) and long-term outcome of patients. Tumors of craniocervical junction, intramedullary metastasis and cauda equina tumors were excluded.

Results: From 1990, 48 patients with spinal cavernoma were treated at our centre. 23 female (47.9%) and 25 male (52.1%) were identified (mean age: 41.3 years, SD: 15.6 years) with the lesion being located thoracally (56.3%), cervically (39.5%) and in 4.2% thoracolumbal. 18.8% of patients reported on a slow progressive decline in neurological function, 33.3% showed a discrete and acute episodes of neurological deterioration with various degrees of recovery inbetween. 41.7% of patients reported on an acute onset of symptoms either followed by a rapid (16.7%) or gradually progressive decline (25.0%). Microsurgical myelon approach was either performed via the posterior median sulcus (37.5%) or directly in cases where the lesions had contact to the surface (54.2%). In 4 patients (8.3%) a lateral approach dividing the dentate ligament was performed. Functional outcome assessed with the ASIA impairment scale direct postoperative demonstrated 54.2% of patients neurologically unchanged, 33.3% worsened, and 12.5% improved compared to the preoperative state. Worsening or improvement was defined as a change on the scale at least in one category. On long-term follow-up (mean: 79.3 mths, SD: 35.2 mths) 70.8% of patients presented unchanged compared to the preoperative status, 6.3% worsened, and 22.9% improved.

Conclusions: Microsurgery proves to be an effective and safe treatment measure eliminating intramedullary spinal cavernoma. Major aim is the complete resection of the lesion without postoperative worsening of neurological deficits, which can be achieved in over 90% of treated cases on long-term follow-up.