Clinical presentation and optimal management for intramedullary cavernous malformations.
OBJECTIVE
Intramedullary cavernous malformations (CMs) account for approximately 5% of all intraspinal lesions. The purpose of this study was to define the spectrum of presentation for spinal intramedullary CMs and the results of microsurgery for these benign but clinically progressive lesions.


METHODS
Retrospective chart review was performed in 26 patients with histologically diagnosed CMs. All patients had undergone preoperative magnetic resonance (MR) imaging studies. All patients were treated with a laminectomy and microsurgical resection of the malformation.


CONCLUSIONS
The MR imaging findings are diagnostic for intramedullary CMs; these lesions abut a pial surface and have a characteristic imaging pattern. Spinal intramedullary CMs present with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage inside the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and resulting gliotic reaction to blood products. Surgery and total removal of the lesion tends to halt progression of symptoms.
Jallo
George I
GI
Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA. gjallo1@jhmi.edu
Freed
Diana
D
Zareck
Michelle
M
Epstein
Fred
F
Kothbauer
Karl F
KF
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018450:Disease Progression; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D006470:Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery