Spinal intramedullary cavernous angiomas: A literature metaanalysis

Canavero, Sergio; Pagni, C. A.; Duca, Sergio; Bradac, Gianni Boris

doi:10.1016/0090-3019(94)90031-0

Cited by 74 publications

(47 citation statements)

References 36 publications

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“…The prognostic factors of poor outcomes reported in the literature are preoperative status and symptom duration. 1,4 However, three of the patients (cases 6, 7 and 14) with poor outcomes in our study did not have a long symptom duration or poor preoperative status in comparison to the other patients. Although approach through a short distance to the lesion is a basic concept of surgical removal, dorsolateral myelotomy could induce postoperative neurological deficits by insulting dorsal root afferents and the lateral corticospinal tract.…”

Section: Clinical Outcomesmentioning

confidence: 49%

“…Although radiosurgery has been used in the treatment of intracranial CAs, no data exist for spinal intramedullary CAs. 4 Because the natural history of spinal intramedullary CAs is uncertain yet, surgical removal of asymptomatic spinal intramedullary CAs is still under debate. 1 However, only surgical removal of spinal intramedullary CAs in symptomatic patients provides a way to stop progression and to reduce the neurological symptoms.…”

Section: Introductionmentioning

confidence: 99%

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The clinical outcomes after complete surgical resection of intramedullary cavernous angiomas: changes in motor and sensory symptoms

Chung

2008

Spinal Cord

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Study design: Evaluation of the surgical effects of patients with intramedullary spinal cord cavernous angiomas (CAs). Objectives: To assess the sensory and motor deficits in the clinical symptoms of patients with intramedullary CAs after complete surgical resection. Setting: Seoul National University Hospital, Korea. Results: The patients' mean ASIA score at follow-up was increased in comparison to the preoperative score (97.2±5.3 vs 95.2±7.6, P ¼ 0.201), but this difference was not significant. The mean JOA motor score at follow-up was slightly increased in comparison to the preoperative score (7.2±1.3 vs 6.8±1.3, P ¼ 0.107). There was a significant difference between the patients' preoperative and follow-up JOA sensory score (4.3 ± 1.0 vs 4.9 ± 0.9, P ¼ 0.007). The rates of complete resolution of motor and sensory deficits were 45.5% (5/11 patients) and 7.1% (1/14 patients), respectively. Conclusion: Although complete surgical resection could improve the clinical symptoms of intramedullary CAs, the sensory deficits usually remain in the long-term period after complete resection.

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Section: Clinical Outcomesmentioning

confidence: 49%

Section: Introductionmentioning

confidence: 99%

The clinical outcomes after complete surgical resection of intramedullary cavernous angiomas: changes in motor and sensory symptoms

Chung

2008

Spinal Cord

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“…51 A limited number of reviews have discussed the literature concerning ISCCMs. 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.…”

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confidence: 99%

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

Badhiwala¹,

Farrokhyar

Alhazzani

et al. 2014

SPI

115

118

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Object Information pertaining to the natural history of intramedullary spinal cord cavernous malformations (ISCCMs) and patient outcomes after surgery is scarce. To evaluate factors associated with favorable outcomes for patients with surgically and conservatively managed ISCCMs, the authors performed a systematic review and metaanalysis of the literature. In addition, they included their single-center series of ISCCMs. Methods The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and The Cochrane Library for studies published through June 2013 that reported cases of ISCCMs. Data from all eligible studies were used to examine the epidemiology, clinical features, and neurological outcomes of patients with surgically managed and conservatively treated ISCCMs. To evaluate several variables as predictors of favorable neurological outcomes, the authors conducted a meta-analysis of individual patient data and performed univariate and multivariate logistic regression analyses. Variables included patient age, patient sex, lesion spinal level, lesion size, cerebral cavernomas, family history of cavernous malformations, clinical course, presenting symptoms, treatment strategy (operative or conservative), symptom duration, surgical approach, spinal location, and extent of resection. In addition, they performed a meta-analysis to determine a pooled estimate of the annual hemorrhage rate of ISCCMs. Results Eligibility criteria were met by 40 studies, totaling 632 patients, including the authors' institutional series of 24 patients. Mean patient age was 39.1 years (range 2–80 years), and the male-to-female ratio was 1.1:1. Spinal levels of cavernomas were cervical (38%), cervicothoracic (2.4%), thoracic (55.2%), thoracolumbar (0.6%), lumbar (2.1%), and conus medullaris (1.7%). Average cavernoma size was 9.2 mm. Associated cerebral cavernomas occurred in 16.5% of patients, and a family history of cavernous malformation was found for 11.9% of evaluated patients. Clinical course was acute with stepwise progression for 45.4% of patients and slowly progressive for 54.6%. Symptoms were motor (60.5%), sensory (57.8%), pain (33.8%), bladder and/or bowel (23.6%), respiratory distress (0.5%), or absent (asymptomatic; 0.9%). The calculated pooled annual rate of hemorrhage was 2.1% (95% CI 1.3%–3.3%). Most (89.9%) patients underwent resection, and 10.1% underwent conservative management (observation). Outcomes were better for those who underwent resection than for those who underwent conservative management (OR 2.79, 95% CI 1.46–5.33, p = 0.002). A positive correlation with improved neurological outcomes was found for resection within 3 months of symptom onset (OR 2.11, 95% CI 1.31–3.41, p = 0.002), hemilaminectomy approach (OR 3.20, 95% CI 1.16–8.86, p = 0.03), and gross-total resection (OR 3.61, 95% CI 1.24–10.52, p = 0.02). Better outcomes were predicted by an acute clinical course (OR 1.72, 95% CI 1.10–2.68, p = 0.02) and motor symptoms (OR 1.76, 95% CI 1.08–2.86, p = 0.02); poor neurological recovery was predicted by sensory symptoms (OR 0.58, 95% CI 0.35–0.98, p = 0.04). Rates of neurological improvement after resection were no higher for patients with superficial ISCCMs than for those with deep-seated ISCCMs (OR 1.36, 95% CI 0.71–2.60, p = 0.36). Conclusions Intramedullary spinal cord cavernous malformations tend to be clinically progressive. The authors' findings support an operative management plan for patients with a symptomatic ISCCM. Surgical goals include gross-total resection through a more minimally invasive hemilaminectomy approach within 3 months of presentation.

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“…Costumam manifestar-se na quarta década de vida. 3,7 Há predileção pela ocorrência na medula torácica e pode haver multiplicidade e ocorrência familiar, o que requer investigações. Podem estar associados a angiomas de pele ou órgãos internos ou ocorrer após a radioterapia.…”

Section: Introductionunclassified

“…Com o advento da ressonância nuclear magnética (RNM) na década de 1980, o número de diagnósticos e cirurgias aumentou, o cavernoma foi reconhecido como causa de mielopatia aguda principalmente em jovens e os pacientes portadores de cavernomatoses puderam ter sua medula mapeada. [3][4][5]9,15 Cavernomas podem se manifestar em qualquer idade e 10% deles são observados na população pediá-trica, em que as manifestações parecem mais agudas. Costumam manifestar-se na quarta década de vida.…”

Section: Introductionunclassified

Cavernomas da medula torácica: Considerações e relato de um caso-exemplo

Joaquim¹,

Patriota²,

Bianco³

2010

Arq Bras Neurocir

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RESUMO Os autores discutem o tratamento dos cavernomas da medula torácica e apresentam um caso como exemplo. Essas lesões são passíveis de ressecção cirúrgica preventiva de déficits neurológicos. PALAVRAS-CHAVECavernoma. Angioma cavernoso. Cavernoma medular. ABSTRACT Considerations on thoracic spinal cord cavernomas and case reportThe authors discuss the treatment of the thoracic spinal cord cavernomas. A case is presented. These lesions are elegible to be ressected before the neurological deficits occur. KEY WORDS Cavernoma. Cavernous angioma. Spinal cord cavernoma. IntroduçãoO primeiro cavernoma medular foi descrito em 1900, e a primeira cirurgia, em 1912. Até 1985, apenas 19 casos haviam sido descritos na literatura. Com o advento da ressonância nuclear magnética (RNM) na década de 1980, o número de diagnósticos e cirurgias aumentou, o cavernoma foi reconhecido como causa de mielopatia aguda principalmente em jovens e os pacientes portadores de cavernomatoses puderam ter sua medula mapeada. [3][4][5]9,15 Cavernomas podem se manifestar em qualquer idade e 10% deles são observados na população pediá-trica, em que as manifestações parecem mais agudas. Costumam manifestar-se na quarta década de vida. 3,7 Há predileção pela ocorrência na medula torácica e pode haver multiplicidade e ocorrência familiar, o que requer investigações. Podem estar associados a angiomas de pele ou órgãos internos ou ocorrer após a radioterapia. 10,11,13 Ocorrem como lesões semelhantes a framboesas circundadas de gliose e um anel de hemossiderina. O plano gliótico é frequentemente infiltrado por prolongamentos dos cavernomas. As dimensões variam de milímetros a centímetros e o crescimento lento permite adaptabilidade medular. Às vezes, a superfície da medula está amarelada e há focos de hemorragias antigas adjacentes. Calcificações podem ocorrer. 1,4 DiagnósticoPodem ocorrer sintomas agudos, progressivos ou episódicos e recorrentes. Os sintomas agudos devem-se a hemorragias, e hematoma intramedular associada pode ocorrer. Há déficits sensitivos, motores e esfincterianos e pode haver dor radicular correspondente ao nível medular do cavernoma ou pode ocorrer hemorragia subaracnoidea e hidrocefalia. 2,5,6

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Spinal intramedullary cavernous angiomas: A literature metaanalysis

Cited by 74 publications

References 36 publications

The clinical outcomes after complete surgical resection of intramedullary cavernous angiomas: changes in motor and sensory symptoms

The clinical outcomes after complete surgical resection of intramedullary cavernous angiomas: changes in motor and sensory symptoms

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

Cavernomas da medula torácica: Considerações e relato de um caso-exemplo

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