title: Comparison of Outcome Between Surgical and Conservative Management of Symptomatic Spinal Cord Cavernous Malformations.
abstract: BACKGROUND
  Intramedullary cavernous malformations (CMs) are rare lesions with unclear natural history.
  
  
  OBJECTIVE
  To compare the functional outcomes of spinal CMs managed surgically and conservatively.
  
  
  METHODS
  We performed a retrospective study of patients diagnosed with intramedullary CMs seen at our institution from 2006 to 2013. Functional outcomes of patients were assessed by treatment modality with the Modified McCormick Scale and Karnofsky Performance Status.
  
  
  RESULTS
  We identified a total of 85 study-eligible patients; 51 (60.0%) were male. Mean age of patients was 40.5 years. Fifty-eight patients underwent microsurgical removal, and 27 patients underwent conservative management. All patients except 1 harbored a single symptomatic intramedullary CM. Mean follow-up time was 42.8 months. For the surgical group (n = 58), 51 CMs were completely resected. During the follow-up period, 40 patients (69.0%) within the surgical group had improvement in neurological state, 16 patients (27.6%) remained unchanged, and 2 patients (3.4%) experienced deteriorated functional status. In the conservative group, 4 patients (14.8%) had improvement of their symptoms, 19 patients (70.4%) remained in baseline, and 4 patients (14.8%) deteriorated. No significant statistical difference was observed in follow-up Karnofsky Performance Status assessment (odds ratio = 0.89; 95% confidence interval = 0.73-1.08; P = .15) or Modified McCormick Scale assessment (odds ratio = 0.90; 95% confidence interval = 0.74-1.10; P = .30) after adjustment for preoperative lesion size and location. Annual hemorrhagic risk was 3.9% in conservatively managed patients. In contrast, no patients experienced subsequent hemorrhages after surgical resection.
  
  
  CONCLUSIONS
  Surgical resection of intramedullary CMs eliminates the risk of subsequent hemorrhagic and may achieve satisfactory outcome when patients are carefully selected. Although conservative management is recommended in patients at high surgical risk, they should be closely monitored because of persistent hemorrhagic risk.
authors.affiliation: ‡Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; §Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.forename: Wenqing
authors.initials: W
authors.lastname: Jia
authors.forename: Desheng
authors.initials: D
authors.lastname: Kong
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
authors.forename: Guihuai
authors.initials: G
authors.lastname: Wang
authors.forename: Yulun
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013116:Spinal Cord / Q000002:abnormalities* / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000151:congenital / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome