title: Intramedullary spinal cavernoma: clinical presentation, microsurgical approach, and long-term outcome in a cohort of 48 patients.
abstract: 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.
authors.affiliation: Department of Neurological Surgery;
authors.forename: Matthias
authors.initials: M
authors.lastname: Reitz
authors.affiliation: Department of Neurological Surgery;
authors.forename: Till
authors.initials: T
authors.lastname: Burkhardt
authors.affiliation: Institute of Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf; and.
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Department of Spinal Surgery, Asklepios Hospital Wandsbek, Hamburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Raimund
authors.affiliation: Department of Spinal Surgery, Asklepios Hospital Wandsbek, Hamburg, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Fritzsche
authors.affiliation: Department of Neurological Surgery;
authors.forename: Nils Ole
authors.initials: NO
authors.lastname: Schmidt
authors.affiliation: Department of Neurological Surgery;
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
authors.affiliation: Department of Neurological Surgery;
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurological Surgery;
authors.forename: Sven Oliver
authors.initials: SO
authors.lastname: Eicker
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011184:Postoperative Period; D020127:Recovery of Function; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; EC = Epstein and Cooper; IOM = intraoperative electrophysiological monitoring; ISC = intramedullary spinal cavernoma; MEP = motor evoked potential; microsurgery; spinal cavernoma; spinal cord; vascular malformation