Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

Maslehaty, Homajoun; Barth, Harald; Petridis, A. K.; Doukas, Alexandros; Mehdorn, H. Maximilian

doi:10.1007/s00586-011-1898-z

Cited by 25 publications

(13 citation statements)

References 28 publications

(45 reference statements)

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Definition Of Variablesmentioning

confidence: 99%

“…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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Definition Of Variablesmentioning

confidence: 99%

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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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“…With respect to causative treatment options, complete microsurgical removal of the pathology is recognized as the therapy of choice whenever possible. 2,8,11,23,25,27,37 Approaches to the spinal cord are performed either directly to the pathology in cases of ISCs reaching the pial surface or via the central dorsal sulcus (midline myelotomy) for deep-seated lesions. Spinal cord access via the dorsolateral entry zone is especially suitable for superficial lateral pathologies by opening the dentate ligament and gently rotating the spinal cord.…”

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confidence: 99%

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

Reitz¹,

Burkhardt²,

Vettorazzi

et al. 2015

FOC

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OBJECT Intramedullary spinal cavernoma (ISC) is a rare entity and accounts for approximately 5%−12% of all spinal vascular pathologies. The purpose of the present study was to examine the influence of clinical presentation, localization, and different surgical approaches on long-term outcome in patients treated for ISC. METHODS The authors performed a retrospective single-center study of 48 cases of ISC treated microsurgically over the past 28 years. Analyzed factors included preoperative clinical history, microsurgical strategies, neurological outcome (American Spinal Injury Association [ASIA] grade, Epstein and Cooper grade), and the occurrence of postoperative spinal ataxia. Univariate analysis was performed to identify factors influencing long-term outcome. RESULTS Preoperatively, 18.8% of all patients experienced a slow, progressive decline in neurological function and 33.3% suffered repetitive episodes of acute neurological deterioration over a time frame of months to years. Moreover, 16.7% noted the sudden onset of a severe neurological deficit, whereas 25% experienced the sudden onset of symptoms with a subsequent gradually progressive decline in neurological function. On long-term follow-up after treatment (mean ± SD, 79.3 ± 35.2 months), 70.8% of patients showed no change in neurological function, 6.3% suffered from a decline, and 22.9% improved neurologically. Thoracolumbar localization (p = 0.043), low preoperative Epstein and Cooper grade for the lower extremities (p < 0.001), and a low preoperative ASIA grade (p < 0.001) were identified as factors associated with an unfavorable outcome (ASIA Grade A-C). The rate of spinal ataxia related to surgical approach was 16.7%. CONCLUSION Postoperative neurological function in ISC patients is determined by the preoperative neurological status. On long-term follow-up after microsurgical treatment, 93.7% of patients presented with a stable or improved condition (ASIA grade); thus, definite microsurgical treatment should be considered as long as patients present with only mild symptoms after the diagnosis of symptomatic ISC.

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“…The rate of rebleeding is unknown, but because they seem more aggressive than intracranial cavernomas, elective treatment is proposed. [38][39][40][41]…”

Section: Vascular Lesionsmentioning

confidence: 99%

Nontraumatic Emergency of the Spine

Llopis

Belloch

Gallegos

et al. 2017

Semin Musculoskelet Radiol

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Nontraumatic spinal emergencies can have many different causes. Clinical symptoms may be nonspecific, and therefore radiology plays a key role in diagnosing and managing these patients. There is considerable time pressure in these situations because the development of irreversible myelopathy depends not only on the cause but also on the time elapsed between the start of compression and the decompression. To avoid structural cord damage, decompression should be done within 6 to 8 hours after the start of the compression. If patients still walk when the lesion is detected, they have a 90 to 100% chance of walking when the lesion is treated immediately.Magnetic resonance imaging is the primary method for the evaluation of spinal emergencies. An appropriate fast protocol should be used, adding some special sequences depending on the clinical scenario.In this review we use a simple anatomical approach that can be applied in an acute practical clinical setting, allowing an accurate differential diagnosis that will guide subsequent therapeutic actions. We highlight key radiologic features that will help nonspecialized radiologists make a precise diagnosis.

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Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

Cited by 25 publications

References 28 publications

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

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

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

Nontraumatic Emergency of the Spine

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