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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Intramedullary spinal cavernomas: Assessment of pre-operative clinical and radiographic parameters and neurological outcome in a single-center case series of 27 patients

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  • Konstantin Hockel - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Mario Moraes - Natal, Brazil
  • Marco Skardelly - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Florian Ebner - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Guilherme Lepski - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
  • Marcos Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.11.06

doi: 10.3205/17dgnc240, urn:nbn:de:0183-17dgnc2407

Published: June 9, 2017

© 2017 Hockel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Due to repetitive hemorrhage into the spinal cord the spontaneous course of intramedullary spinal cavernomas often leads to progressive neurological deterioration. On the other hand, surgical removal of an intramedullary lesion, despite modern techniques of microsurgery and neuromonitoring, bears considerable risks. Aim of the study was to identify critical preoperative factors that help to predict long-term neurological outcome.

Methods: A series of 27 consecutive patients with intramedullary spinal cavernomas over the past 12 years was retrospectively evaluated. Preoperative demographic and clinical variables (history of hemorrhage, previous treatments, neurological status) were assessed. In addition to radiographic properties (cavernoma location, central vs. superficial, lesion size) the surgical strategy (timing of surgery, approach, myelotomy vs. superficial evacuation) were evaluated. Pre- and postoperative neurological status was graded according to ASIA classification and rate of improvement (for motor and bladder function) was assessed separately.

Results: Within the cohort mean age was 46 + 12 years and female to male ratio 2.5:1. In the majority of cases (78%) a clear history of previous hemorrhage was present with multiple events in 33%. Cavernoma location was cervical (n=10), thoracic (n=16) and at the conus level in 1 case. Central or ventral location within the myelon was identified in 7 cases. In 45% of the cases surgical therapy was initiated within 6 months of the symptom onset. Complete removal was intended in all cases, although 2 patients had recurrent cavernomas (7%). Overall 12 patients showed significant clinical improvement and none exhibited worsening of symptoms at follow-up (6-12 months). Postoperative high-grade neurological deficit (ASIA A-C) without any improvement was identified in 3 cases; all of them had long-term, pre-existing severe neurological deficits (p<0.005 Chi2).

Conclusion: The presented data support our strategy of early surgical intervention in intramedullary spinal cavernomas. Neither timing of surgery (e.g. early after symptom onset), cavernoma size, location within the myelon, nor the necessity for myelotomy seem to be associated with unfavorable neurological outcome after surgery, whereas chances for neurological improvement in patients with long-term, high-grade myelopathy are little.