title: Clinical presentation and optimal management for intramedullary cavernous malformations.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA. gjallo1@jhmi.edu
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.forename: Diana
authors.initials: D
authors.lastname: Freed
authors.forename: Michelle
authors.initials: M
authors.lastname: Zareck
authors.forename: Fred
authors.initials: F
authors.lastname: Epstein
authors.forename: Karl F
authors.initials: KF
authors.lastname: Kothbauer
mesh_terms: 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