Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature.
OBJECTIVE
Spinal cavernomas are rare, but can cause significant neurological deficits due to mass effect and extralesional hemorrhage. The authors present their results of microsurgical treatment of 14 consecutive patients with spinal cavernoma, and review the literature.


METHODS
Of the 376 patients with cavernomas of the CNS treated at Helsinki University Central Hospital (a catchment area close to 2 million inhabitants) between January 1980 and June 2009, 14 (4%) had a spinal cavernoma. The authors reexamined and analyzed the patient files and images retrospectively. Median patient age at presentation was 45 years (range 20–57 years). The female/male ratio was equal. Median duration of symptoms before admission to the department was 12 months (range 0.1–168 months). Patients suffered from sensorimotor paresis, radicular pain, or neurogenic micturition disorders in different combinations or separately. Hemorrhage had occurred in 7 patients (50%) before surgery. In 9 patients (64%) the cavernoma was intramedullary, in 4 (29%) extradural, and in 1 intradural extramedullary. On MR imaging, 6 patients (43%) had a cavernoma in the cervical region, 7 (50%) in the thoracic region, and 1 (7%) in the lumbar region.


RESULTS
Postoperatively, patients were followed up for a median of 3 years (range 1–10 years). At follow-up, 13 patients (93%) experienced significant improvement in motor ability after surgery, and all patients were able to walk with or without aid. Ten of the 11 patients with pain syndrome (91%) showed significant pain relief without recurrence. Micturition disorder was noted in 6 patients (43%) at follow-up, but in 5 the condition had existed before surgery. No patient improved in bladder function after surgery, and 1 patient developed micturition dysfunction postoperatively.


CONCLUSIONS
Microsurgical removal of spinal cavernomas alleviates sensorimotor deficits and pain caused by mass effect and hemorrhage. However, bladder dysfunction remains unchanged after surgery.
Kivelev
Juri
J
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. juri.kivelev@hus.fi
Niemelä
Mika
M
Hernesniemi
Juha
J
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply; D008866:Microsurgery; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology; D010146:Pain / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014555:Urination Disorders / Q000209:etiology; D055815:Young Adult