Article
Spinal cord cavernous malformations – a 25 year experience in 42 surgical treated cases
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Authors
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F. Raimund
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie
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T. Burkhardt
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie
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N.O. Schmidt
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie
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J. Regelsberger
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie
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M. Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie
| Published: | June 4, 2012 |
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Outline
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Objective: Spinal cord cavernous malformations (CM) are rare, they account for 5–12% of all spinal vascular tumors. The annual bleeding rate is reported to reach 4.5% assuming lesion presence since birth, and an annual re-bleeding rate of 66% per year. Therapeutic decisions are based on clinical and neuroradiologic appearance.
Methods: We report on a consecutive series of 42 surgical treated patients in a single centre experience between June 1986 and June 2011. There were 22 female (52.4%) and 20 male (47.6%) patients with a mean age 42.3 years (SD 15.9 years) ranging from 17 to 78 years. All patients were treated surgically using a dorsal laminoplasty and myelotomy. The lesion was resected by evacuation of the haematoma and shrinking the CM by bipolar coagulation if feasible. The entire resection was performed throughout the gliotic layer surrounding the cavernoma, and residual pathologic tissue was finally removed with a laser if necessary. Associated venous vessels were preserved as far as possible.
Results: On day following surgery 76.2% of the patients felt their clinical situation unchanged, 16.6% worsened (mainly related to disturbance of the posterior funiculi), and 7.2% experienced an improvement. Three patients (7.4%) suffered from a hemorrhage within the first 24 hours which led to second surgery. On long-term follow-up 23.8% of patients showed an improvement, 64.3% presented unchanged, and 11.9% suffered from worsening of their clinical situation compared to the preoperative state. In two patients (4.7%) MRI control revealed residual lesions which led to second surgery.
Conclusions: Our experience in 42 cases demonstrates that surgical resection of intramedullary CM is associated with good clinical results on long-term follow-up, in which clinical improvement may be expected in the first tow years following surgery. Ideal timing of surgery seems to be 4–6 weeks after an initial bleeding when patients already have recovered broadly and gliotic changes have already taken place minimizing surgical trauma. Progressive neurologic deficits caused by re-bleeding might necessitate immediate surgical resection.
