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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Intramedullary spinal cord cavernomas: Annual bleeding rate, clinical features and surgical technique

Intramedulläre spinale Kavernome: Jährliche Blutungsrate, klinische Eigenschaften und chirurgische Technik

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  • corresponding author L. Benes - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • L.G. Bian - Department of Neurosurgery, Rui-Jin Hospital, Shanghai Second Medical University, Shanghai, People Republic of China
  • W. Tirakotai - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • U. Sure - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • D.M. Schulte - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • H. Bertalanffy - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.11.07

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc154.shtml

Published: May 8, 2006

© 2006 Benes 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

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Objective: The purpose of this study was to define the annual hemorrhage rate of intramedullary spinal cord cavernomas (ISCCs) in comparison with intracranial cavernomas in order to determine the potential risk of lesional bleeding and to analyze the clinical features and the surgical technique of unilateral hemilaminectomy for treating ISCCs.

Methods: Out of a group of intramedullary spinal cord lesions (n=36) we did a retrospectivelanalysis on eleven individuals with intramedullary spinal cord cavernomas operated on via an unilateral hemilaminectomy between January 1998 and December 2004. The annual haemorrhage rate, sex distribution and mean age were determined and compared with cerebral/cerebellar (n=145) and brainstem cavernomas (n=61) using statistical analysis (chi-square test, t-test). The pre- and postoperative neurological findings were evaluated using the Frankel scale.

Results: Seven females and four males (mean age 39 years) harbouring symptomatic ISCCs could be identified. The female-male-ratio was higher than in cerebral/cerebellar (1.2:1) and brainstem cavernomas (1.2:1). The annual retrospective haemorrhage rate was calculated to be 2.8% per patient/year, slightly lower than for cerebral/cerebellar and brain stem cavernomas (3.1%, respectively). Hemilaminectomy was selected for all individuals. All cavernomas were completely removed. Eight of eleven patients experienced an improvement of their neurological status (Frankel Grade E (n=6), D (n=2)) and in three patients clinical features remained unchanged during the follow-up period.

Conclusions: As a result of the calculated bleeding risk in symptomatic intramedullary spinal cord cavernomas, total resection should be achieved to avoid recurrence and rebleeding from the remnant. Selection of a less invasive approach (hemilaminectomy) combined with intraoperative somatosensory evoked potentials and ultrasonography leads to a favourable outcome and prevents additional morbidity.