Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this study, the authors present a review of a series of 20 intramedullary spinal cord cavernous malformations (SCCMs) with particular focus on MR imaging and prognostic factors.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 1994 and 2009, 20 patients with SCCM were treated under the care of the senior author. The diagnosis was made in all patients after the onset of clinical symptoms. The age of the 9 men and 11 women ranged between 26 and 71 years (median 38.5 years). The duration of symptoms prior to referral ranged from 1 week to 9 years (median 6.5 months). At the time of referral, 4 patients had no significant neurological deficits, 10 patients suffered significant functional restrictions, and 6 patients presented with severe paraparesis and loss of functional strength. None of the patients had complete paraplegia. Seventeen patients underwent microsurgical removal, while 3 patients opted for conservative therapy. For the present analysis, the medical records and MR images and/or reports were reviewed. Classification of length of history, pretreatment status, MR imaging pattern, and treatment modality was done and correlated with outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The cavernoma was located at the cervical level in 8 patients and between T-1 and L-1 in 12 patients. The cavernoma appeared as mainly T2 hyperintense on MR images in 7 patients, mainly T2 hypointense in 2 patients, and mixed in the remaining 10 patients. The craniocaudal extension of the core varied between 5 and 45 mm. In 2 patients with cervical cavernomas, a distinct T2 signal of the spinal cord cranial and distal to the cavernoma was seen, and in a patient with a large thoracic cavernoma, T2 extinction cranial and caudal to the cavernoma was seen as a sign of hemosiderosis. Neurological deficits improved postoperatively in 12 of the surgically treated patients, remained stable in 2, and deteriorated in 3. The 3 patients who were conservatively treated remained stable over a follow-up of 3–9 years. Postoperative improvement was seen in 5 of 7 surgical patients with a history of symptoms of 2 months or less, 5 of 6 patients with a history of 2–24 months, and in 2 of 4 patients with a history of more than 2 years. Two of the 3 patients with postoperative deterioration had a history of more than 2 years and the third a short history of 1 month.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Although a satisfactory outcome can be achieved through surgical treatment of SCCMs, some patients worsen after surgery or during the postoperative course. Long-term stability is possible in oligosymptomatic conservatively treated patients. The prevalence and pathophysiological importance of segmental spinal cord edema and hemosiderosis is incompletely understood at the present time.</jats:p></jats:sec>

Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data

“…Eligibility criteria were met by 39 articles, totaling 608 patients 1,5,6,8,9,11,12,14,15,17,[20][21][22][23]27,28,30,[34][35][36][37][38][39][40][41][42]45,46,49,50,53,54,58,59,[62][63][64]67,73 (Fig. 1), in addition to our institutional series of 24 patients with ISCCMs (total of 40 series and 632 patients).…”

“…Included articles described use of various methods to report outcomes, most commonly a simple scale of better, same, or worse. Several articles reported use of a standardized scoring tool for assessing neurological function, including the McCormick, 1,12,15,17,20,30,35,37,39,40 Frankel, 5,6,8,42,53,59,73 American Spinal Injury Association impairment, 50 and Aminoff-Logue disability 36 scales. For each included study, we defined improved, unchanged, or worsened neurological function the same as that reported by the authors of eligible articles.…”

“…7,24,73 Since then, several additional large series have been published. 1,2,6,12,17,20,27,32,34,36,37,39,42,59,62,67 Because of the relative rarity of these lesions, information pertaining to clinical outcomes for patients harboring ISCCMs is scarce.…”

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

“…In such cases, resections required no separate myelotomy and the tumor could be entered directly. This applied to most angioblastomas, 6,38,44,57 some cavernomas, 35,36,55 and a few astrocytomas. Whenever the spinal cord had covered the intramedullary tumor completely, sensory functions suffered permanently to some degree.…”

Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

“…Spinal CMs are increasingly being diagnosed by magnetic resonance imaging (MRI) in patients with varying spinal cord related symptoms or pain syndromes [2,6,7,26]. Spinal CMs can occur along the neuraxis and are predominantly located intramedullary.…”