Clinical presentation and surgical management of intramedullary spinal cord cavernous malformations

Abstract

Object: Intramedullary cavernous malformation (CM) is a rare entity, accounting for 5% of all intraspinal lesions. The objective in this study was to define the clinical characteristics of this disease, detail the surgical approach and technique, and present the clinical outcome.

Methods: Retrospective chart review was performed in 22 patients with histologically confirmed CMs. The authors used a laminectomy approach for midline dorsal lesions, with unilateral radical facetectomy and dentate ligament resection for laterally or ventrally located lesions. Patient profiles, operative indications, surgical approaches, operative findings, complications, and long-term follow-up were reviewed.

Results: The average age of patients in the cohort was 43 +/- 14 years, the average duration of symptoms was 7 +/- 7 months, and the average follow-up was 6 +/- 4 years. The average size of the lesion was 1 +/- 0.4 cm, the average surgical time was 4 +/- 0.96 hours, and the average estimated blood loss was 350 +/- 131 ml. The rate of complication was 5% (1 patient; due to a wound infection). According to the McCormick classification, the score for the cohort was 1.8 +/- 1.2 preoperatively, 2.1 +/- 1.2 postoperatively, and 1.3 +/- 0.65 at late follow-up. (All preceding values are given as the mean +/- SD.) There was a significant neurological improvement at follow-up compared with the preoperative state (p < 0.05). The majority of patients (50%) had a stable outcome compared with their preoperative state, with a large proportion (41%) having an improved outcome. A minority of patients (9%) had a worsened outcome due to dysesthetic pain. Patients with dysesthesia had a longer duration of clinical symptoms prior to surgery compared with patients without dysesthesia (p < 0.05).

Conclusions: The authors demonstrated the safety, efficacy, and durability of their surgical approach for resection of spinal intramedullary CM. Proper examination, preoperative imaging, and prompt surgical intervention were necessary for a satisfactory outcome.