gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Spinal cavernomas – operative strategy and results in 28 patients

Meeting Abstract

Search Medline for

  • D. Wachter - Abteilung für Neurochirurgie, Georg-August-Universität Göttingen, Göttingen
  • V. Rohde - Abteilung für Neurochirurgie, Georg-August-Universität Göttingen, Göttingen; Abteilung für Neurochirurgie, Klinikum der RWTH Aachen, Aachen

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.09.07

DOI: 10.3205/11dgnc064, URN: urn:nbn:de:0183-11dgnc0644

Published: April 28, 2011

© 2011 Wachter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Since 1978, many case reports and small series with 10 patients and less addressing the surgical management of spinal cavernomas have been published. However, only 2 larger series (Visteh 1997, 17 patients; Jallo 2006, 26 patients) exist, which would allow for identifying operative strategies. After having treated 28 patients, we felt encouraged to report our experiences.

Methods: 28 patients (13 men, 15 women, mean age 42 years) were admitted because of paraparesis (36%), hypesthesia (86%) and/or bladder dysfunction (36%). MR imaging revealed a spinal cavernoma, most commonly in the thoracic region. All patients underwent operative resection. The relation between pial surface and cavernoma guided the choice of the bony approach and the myelotomy site.

Results: In 20% of cases a median myelotomy was performed to reach a medially located cavernoma; in these patients a laminectomy/laminoplasty was also performed. In 60% of cases the myelotomy was performed in the area of the DREZ, for which a (partial) hemilaminectomy proved to be sufficient. In the remaining patients with exophytic cavernomas, no myelotomy was necessary and the laterality of the exophytic part guided the bony approach. Immediately after surgery, a neurological worsening was seen in 57%, an improvement in 14% and an unchanged neurological status in 28%. After 6 months, the rate of neurological worsening dropped to 11%, the improvement rate increased to 50%. In 39% of the patients, the symptoms remained unchanged or returned to the preoperative status.

Conclusions: Given the annual bleeding rate between 1.4 and 4.5%/year and the mean age at manifestation time (36.5 years), the chance to experience a neurological decline over a lifetime is higher than the 11% risk of neurological worsening due to surgery. The exact localization of the cavernoma in relation to the pial surface guides the bony approach and area of myelotomy. In the majority of patients limited approaches are sufficient for successful cavernoma removal.