Intramedullary spinal cavernoma: clinical presentation, microsurgical approach, and long-term outcome in a cohort of 48 patients

Reitz, Matthias; Burkhardt, Till; Vettorazzi, Eik; Raimund, Frank; Fritzsche, Erik; Schmidt, Nils Ole; Regelsberger, Jan; Westphal, Manfred; Eicker, Sven Oliver

doi:10.3171/2015.5.focus15153

Cited by 36 publications

(22 citation statements)

References 38 publications

(41 reference statements)

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“…According to the literature, 22.9% to 90.0% of all patients showed improvement in functional status after resection of the lesion, whereas 10.0% to 73.0% remained unchanged. A total of 21.4% were reported to have deteriorated postoperatively compared with the baseline condition 3 , 8 , 17 , 27 . In the present study, 84.6% of surgically treated patients improved, 15.4% remained unchanged, and none showed deteriorated functional status.…”

Section: Discussionsupporting

confidence: 43%

“…Resection is the definitive treatment and can provide good outcomes (Table 4). 1 , 3 , 5, 6, 7 , 9 , 11, 12, 13, 14, 15, 16, 17, 18 , 20, 21, 22, 23, 24, 25, 26 In a retrospective review of conservatively treated SCCMs, 14.8% of the patients worsened during a mean follow-up duration of 33.9 months 10 . In a systematic review and meta-analysis reported in the literature, 11.3% of conservatively treated patients showed worse functions after follow-up than at initial presentation 3 .…”

Section: Discussionmentioning

confidence: 99%

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Conservative and Surgical Management of Spinal Cord Cavernous Malformations

Ohnishi

Nakajima

Takenaka

et al. 2020

World Neurosurgery: X

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ObjectivesWe present a case series of spinal cord cavernous malformations (SCCMs) to describe clinical presentation and outcomes of both surgical and conservative management.MethodsThe clinical courses of patients diagnosed with SCCMs at our institution were retrospectively reviewed. Neurologic symptoms were evaluated using the Modified McCormick Scale.ResultsA total of 18 patients were identified. Five patients (27.8%) presented with acute onset bleeding, 4 of whom underwent immediate surgical resection. Thirteen patients (72.2%) were initially managed conservatively. Eight patients (38.9%) developed a hemorrhage during follow-up, and 8 (38.9%) required surgical resection due to bleeding or neurological worsening. The mean (range) duration from primary symptoms to subsequent hemorrhage or deterioration of symptoms was 1.42 (range: 0.25–4.33) years. The mean duration from primary symptoms to surgery was 2.10 (range: 0.25–5.0) years. No patients experienced subsequent hemorrhage after surgical resection. Eleven patients (84.6%) in the surgery group showed improved neurological status, and 2 patients (15.4%) remained unchanged. The annualized subsequent hemorrhage risk was 3.7%. Patients in the immediate surgical group had a significantly larger lesion compared with those in the conservative group. There was significance between the worst Modified McCormick Scale grades at the time of debilitating symptoms and the length of hemorrhage, but not the size of the lesion.ConclusionsSurgery for SCCMs resulted in no recurrence of hemorrhage or exacerbation of neurological symptoms, and should be considered for patients who experienced acute onset of hemorrhage or debilitating symptoms during follow-up.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Conservative and Surgical Management of Spinal Cord Cavernous Malformations

Ohnishi

Nakajima

Takenaka

et al. 2020

World Neurosurgery: X

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“…Th e risk increases immediately aft er a hemorrhagic episode and decreases over time. In addition, this risk is associated with other factors such as number of lesions and male gender 2,3 .…”

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confidence: 99%

Cervical Intramedullary Cavernoma in Children: Case report and literature review

Ary¹,

Oliveira²,

Cavalcante-Neto³

et al. 2019

jbnc

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Case presentation: A 10-year-old male patient was admitted due to posterior cervicalgia, vomiting and progressive generalized weakness. Physical examination showed difficulty in ambulation and tetraparesis. Magnetic resonance imaging (MRI) of the cervical medulla enhanced by the contrast agent, gadolinium, showed a poorly contrasted mass with a hemorrhagic center. We undertook a posterior cervicotomy (C1-C3). Post-operative evolution was satisfactory with complete regression of the deficits 90 days after surgery. Control MRI at intervals of 1 and 4 years confirmed absence of the tumor. Discussion: Cavernomas are vascular malformations, consisting of coarsely dilated vascular channels and coated by a single layer of endothelial cells, devoid of endothelium and myothelium. They represent only 5-12% of all vascular pathologies of the medulla, with only 10% affecting the pediatric population. There are only thirty cases of pediatric intramedullary spinal cavernomas in the literature, with predominance among males (2.1:1). Thoracic and cervical spinal cavernomas consist in 55% and 45% of the cases, respectively. In six cases (20%) cavernomatous lesions were associated with synchronic intracranial cavernoma. Among the reported cases, only one had poor evolution after surgery, whereas six patients persisted with prior symptoms. Conclusion: Spinal intramedullary cavernomas are rare entities, especially in the pediatric population, and are treated with surgery which improves prior neurologic deficits, besides preventing rebleeding

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“…This imaging pattern is pathognomonic and may appear as incidental findings in asymptomatic patients who underwent radiological examinations for other reasons. Computed tomography (CT) may show an isodense aspect with increased nonspecific density due to bleeding or microcalcifications 1,2 .…”

mentioning

confidence: 99%

Cervical Intramedullary Cavernoma in Children: case report and literature review

Ary¹,

Oliveira²,

Cavalcante-Neto³

et al. 2019

jbnc

View full text Add to dashboard Cite

Case presentation: A 10-year-old male patient was admitted due to posterior cervicalgia, vomiting and progressive generalizedweakness. Physical examination showed difficulty in ambulation and tetraparesis. Gadolinium-loaded magnetic resonance imaging(MRI) of the cervical medulla, showed a poorly contrasted mass with a hemorrhagic center. We undertook a posterior cervicotomy(C1-C3). Post-operative evolution was satisfactory with complete regression of the deficits 90 days after the surgery. Control MRIat intervals of 1 and 4 years confirmed absence of the tumor. Discussion: Cavernomas are vascular malformations, consisting ofcoarsely dilated vascular channels and coated by a single layer of endothelial cells, devoid of endothelium and myothelium. Theyrepresent only 5-12% of all vascular pathologies of the medulla, with only 10% affecting the pediatric population. There are onlythirty cases of pediatric intramedullary spinal cavernomas in the literature, with predominance among males (2.1:1). Thoracic andcervical spinal cavernomas consist in 55% and 45% of the cases, respectively. In six cases (20%) cavernomatous lesions were associatedwith synchronic intracranial cavernoma. Among the reported cases, only one had poor evolution after surgery, whereas six patientspersisted with prior symptoms. Conclusion: Spinal intramedullary cavernomas are rare entities, especially in the pediatric population,and are treated with surgery which improves prior neurologic deficits, besides preventing rebleeding.

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Intramedullary spinal cavernoma: clinical presentation, microsurgical approach, and long-term outcome in a cohort of 48 patients

Cited by 36 publications

References 38 publications

Conservative and Surgical Management of Spinal Cord Cavernous Malformations

Conservative and Surgical Management of Spinal Cord Cavernous Malformations

Cervical Intramedullary Cavernoma in Children: Case report and literature review

Cervical Intramedullary Cavernoma in Children: case report and literature review

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