Residual and Recurrent Spinal Cord Cavernous Malformations: Outcomes and Techniques to Optimize Resection and a Systematic Review of the Literature

Abstract

BACKGROUND: Intramedullary spinal cord cavernous malformations (SCCMs) account for only 5% of overall cavernous malformations (CMs). The occurrence of recurrent or residual SCCMs has not been well discussed, nor have the technical nuances of resection. OBJECTIVE: To assess the characteristics of residual SCCMs and surgical outcomes and describe the techniques to avoid leaving lesion remnants during primary resection. METHODS: Demographic, radiologic, intraoperative findings and surgical outcomes data for a cohort of surgically managed intramedullary SCCMs were obtained from an institutional database and retrospectively analyzed. A systematic literature review was performed using PRISMA guidelines. RESULTS: Of 146 SCCM resections identified, 17 were for residual lesions (12%). Patients with residuals included 13 men and 4 women, with a mean age of 43 years (range 16-70). All patients with residual SCCMs had symptomatic presentations: sensory deficits, paraparesis, spasticity, and pain. Residuals occurred between 3 and 264 months after initial resection. Approaches for 136 cases included posterior midline myelotomy (28.7%, n = 39), pial surface entry (37.5%, n = 51), dorsal root entry zone (27.9%, n = 38), and lateral entry (5.9%, n = 8). Follow-up outcomes were similar for patients with primary and residual lesions, with the majority having no change in modified Rankin Scale score (63% [59/93] vs 75% [9/12], respectively, P = .98). CONCLUSION: SCCMs may cause significant symptoms. During primary resection, care should be taken to avoid leaving residual lesion remnants, which can lead to future hemorrhagic events and neurological morbidity. However, satisfactory results are achievable even with secondary or tertiary resections.

Radiation-induced cavernous malformations in the spine: patient series

“…There are several advantages to the surgical management of CMs, including the potential for definitive treatment, reduction in bleeding risk, and improvement in symptoms. Correspondingly, a complication-free resection of these lesions is essential to achieve an unchanged or improved outcome and reveals the true benefit of resection with relief of mass effect, 34 even for recurrent cases. 35 None of our patients experienced intraoperative or immediate postoperative complications.…”

Spinal Dorsal Intradural Arteriovenous Fistulas

“…13 Table 1 summarizes the reported literature on the epidemiologic and clinical characteristics and presenting symptoms of DI-AVFs by the involved spine region. 4,6,7,10,12,[15][16][17][18]20,21,25,26,[28][29][30][31][32][33][34] Figure 2 demonstrates the prevalence of DI-AVFs over spinal regions 35 ; data are for 59 cases, obtained as part of a retrospective analysis of 146 surgically managed intramedullary spinal cord cavernous malformations treated at our institution. 4,6,7,10,12,[15][16][17][18]20,21,26,[28][29][30][31][32][33][34]…”

“…Data were obtained as part of a retrospective analysis of 146 surgically managed intramedullary spinal cord cavernous malformations treated at our institution. 35 The figure shows the distribution of the dorsal dural fistulas by the 4 spinal regions: (1) craniocervical junction (n = 13 patients, 22%), (2) subaxial cervical (n = 2 patients, 3%), (3) thoracic (n = 33 patients, 55.9%), and (4) lumbosacral (n = 11 patients, 19%). DI-AVF = dorsal intradural arteriovenous fistula; L = spinal level; O/C = occipital-cervical.…”

Resection of a Thoracic Intradural Extramedullary Cavernoma Using Real-Time Intraoperative Ultrasound: 2-Dimensional Operative Video

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Spinal cavernomas are rare pathological entities. [1][2][3] Intradural extramedullary cavernomas of the spinal cord are especially rare, with only 71 cases previously described. 4 As with cavernous malformations elsewhere in the central nervous system, these lesions are susceptible to spontaneous hemorrhage.

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