Skip to main content

Advertisement

SpringerLink
Log in

Prediction of outcomes for symptomatic spinal cavernous malformation surgery: a multicenter prospective clinical study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Clinical outcome of spinal cavernous malformation (SCM) varies because of its unclear natural history, and reliable prognostic prediction model for SCM patients is limited. The aim of the present study was to investigate potential factors that predict one-year neurological status in postoperative patients with SCM.

Methods

This was a multicenter prospective observational study in consecutive patients with SCMs. SCMs treated microsurgically between January 2015 and January 2021 were included. Outcome was defined as the American Spinal Injury Association Impairment Scale (AIS) grade at one year after operation. Multivariable analyses were used to construct the best predictive model for patient outcomes.

Results

We identified 268 eligible SCM patients. Neurological outcome had worsened from preoperative baseline in 51 patients (19.0%) at one year. In the multivariable logistic regression, the best predictive model for unfavorable outcome included symptom duration ≥ 26 months (95% CI 2.80–16.96, P < 0.001), size ≤ 5 mm (95% CI 1.43–13.50, P = 0.010), complete intramedullary (95% CI 1.69–8.14, P = 0.001), subarachnoid hemorrhage (95% CI 2.92–12.57, P < 0.001), AIS B (95% CI 1.91–40.93, P = 0.005) and AIS C (95% CI 1.12–14.54, P = 0.033).

Conclusions

Admission size of the lesion, morphology, symptom duration, AIS grade and the presence of subarachnoid hemorrhage were strong outcome predictors regarding prognostication of neurological outcome in postoperative patients with SCMs. A decision to surgically remove a symptomatic SCM should be justified by systematic analysis of all factors potentially affecting outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zevgaridis D, Medele RJ, Hamburger C, Steiger HJ, Reulen HJ (1999) Cavernous haemangiomas of the spinal cord. A review of 117 cases. Acta Neurochir (Wien) 141(3):237–245

    Article  CAS  PubMed  Google Scholar 

  2. Vishteh AG, Zabramski JM, Spetzler RF (1999) Patients with spinal cord cavernous malformations are at an increased risk for multiple neuraxis cavernous malformations. Neurosurgery 45(1):30–32 (Discussion 33)

    CAS  PubMed  Google Scholar 

  3. Lu DC, Lawton MT (2010) Clinical presentation and surgical management of intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E12

    Article  PubMed  Google Scholar 

  4. Gross BA, Du R, Popp AJ, Day AL (2010) Intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E14

    Article  PubMed  Google Scholar 

  5. Aoyama T, Hida K, Houkin K (2011) Intramedullary cavernous angiomas of the spinal cord: clinical characteristics of 13 lesions. Neurol Med Chir (Tokyo) 51(8):561–566

    Article  PubMed  Google Scholar 

  6. Cohen-Gadol AA, Jacob JT, Edwards DA, Krauss WE (2006) Coexistence of intracranial and spinal cavernous malformations: a study of prevalence and natural history. J Neurosurg 104(4):376–381

    Article  PubMed  Google Scholar 

  7. Ardeshiri A, Özkan N, Chen B, Stein KP, Miller D, Hütter BO et al (2016) A retrospective and consecutive analysis of the epidemiology and management of spinal cavernomas over the last 20 years in a single center. Neurosurg Rev 39(2):269–276 (Discussion 276)

    Article  PubMed  Google Scholar 

  8. Badhiwala JH, Farrokhyar F, Alhazzani W, Yarascavitch B, Aref M, Algird A et al (2014) Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data. J Neurosurg Spine 21(4):662–676

    Article  PubMed  Google Scholar 

  9. Jallo GI, Freed D, Zareck M, Epstein F, Kothbauer KF (2006) Clinical presentation and optimal management for intramedullary cavernous malformations. Neurosurg Focus 21(1):E10

    Article  PubMed  Google Scholar 

  10. Sandalcioglu IE, Wiedemayer H, Gasser T, Asgari S, Engelhorn T, Stolke D (2003) Intramedullary spinal cord cavernous malformations: clinical features and risk of hemorrhage. Neurosurg Rev 26(4):253–256

    Article  PubMed  Google Scholar 

  11. Kondziella D, Brodersen P, Laursen H, Hansen K (2006) Cavernous hemangioma of the spinal cord-conservative or operative management? Acta Neurol Scand 114(4):287–290

    Article  CAS  PubMed  Google Scholar 

  12. Kharkar S, Shuck J, Conway J, Rigamonti D (2007) The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 60(5):865–872

    Article  PubMed  Google Scholar 

  13. Kivelev J, Niemelä M, Hernesniemi J (2012) Treatment strategies in cavernomas of the brain and spine. J Clin Neurosci 19(4):491–497

    Article  PubMed  Google Scholar 

  14. Velz J, Bozinov O, Sarnthein J, Regli L, Bellut D (2018) The current management of spinal cord cavernoma. J Neurosurg Sci 62(4):383–396

    Article  PubMed  Google Scholar 

  15. Fotakopoulos G, Kivelev J, Andrade-Barazarte H, Tjahjadi M, Goehre F, Hernesniemi J (2021) Outcome in patients with spinal cavernomas presenting with symptoms due to mass effect and/or hemorrhage: conservative versus surgical management: meta-analysis of direct comparison of approach-related complications. World Neurosurg 152:6–18

    Article  PubMed  Google Scholar 

  16. Kim KM, Chung CK, Huh W, Lee WJ, Park SB, Kim CH et al (2013) Clinical outcomes of conservative management of spinal cord cavernous angiomas. Acta Neurochir 155(7):1209–1214

    Article  PubMed  Google Scholar 

  17. Imagama S, Ito Z, Ando K, Kobayashi K, Hida T, Ito K et al (2017) Optimal timing of surgery for intramedullary cavernous hemangioma of the spinal cord in relation to preoperative motor paresis, disease duration, and tumor volume and location. Glob Spine J 7(3):246–253

    Article  Google Scholar 

  18. Steiger HJ, Turowski B, Hänggi D (2010) Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients. Neurosurg Focus 29(3):E13

    Article  PubMed  Google Scholar 

  19. Clark AJ, Ziewacz JE, Safaee M, Lau D, Lyon R, Chou D et al (2013) Intraoperative neuromonitoring with MEPs and prediction of postoperative neurological deficits in patients undergoing surgery for cervical and cervicothoracic myelopathy. Neurosurg Focus 35(1):E7

    Article  PubMed  Google Scholar 

  20. Reitz M, Burkhardt T, Vettorazzi E, Raimund F, Fritzsche E, Schmidt NO et al (2015) Intramedullary spinal cavernoma: clinical presentation, microsurgical approach, and long-term outcome in a cohort of 48 patients. Neurosurg Focus 39(2):E19

    Article  PubMed  Google Scholar 

  21. Zhang L, Yang W, Jia W, Kong D, Yang J, Wang G et al (2016) Comparison of outcome between surgical and conservative management of symptomatic spinal cord cavernous malformations. Neurosurgery 78(4):552–561

    Article  PubMed  Google Scholar 

  22. Goyal A, Rinaldo L, Alkhataybeh R, Kerezoudis P, Alvi MA, Flemming KD et al (2019) Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations. J Neurol Neurosurg Psychiatry 90(6):695–703

    Article  PubMed  Google Scholar 

  23. Ogilvy CS, Louis DN, Ojemann RG (1992) Intramedullary cavernous angiomas of the spinal cord: clinical presentation, pathological features, and surgical management. Neurosurgery 31(2):219–229 (Discussion 229–230)

    Article  CAS  PubMed  Google Scholar 

  24. Maynard FM, Bracken MB, Creasey G, Ditunno JF, Donovan WH, Ducker TB et al (1997) International standards for neurological and functional classification of spinal cord injury. Am Spinal Injury Assoc Spinal Cord 35(5):266–274

    Article  Google Scholar 

  25. Azad TD, Veeravagu A, Li A, Zhang M, Madhugiri V, Steinberg GK (2018) Long-term effectiveness of gross-total resection for symptomatic spinal cord cavernous malformations. Neurosurgery 83(6):1201–1208

    Article  PubMed  Google Scholar 

  26. Ren J, Hong T, He C, Li X, Ma Y, Yu J et al (2019) Surgical approaches and long-term outcomes of intramedullary spinal cord cavernous malformations: a single-center consecutive series of 219 patients. J Neurosurg Spine 31(1):123–132

    Article  PubMed  Google Scholar 

  27. Maslehaty H, Barth H, Petridis AK, Doukas A, Mehdorn HM (2011) Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome. Eur Spine J 20(10):1765–1770

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mitha AP, Turner JD, Abla AA, Vishteh AG, Spetzler RF (2011) Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience. J Neurosurg Spine 14(5):605–611

    Article  PubMed  Google Scholar 

  29. Tong X, Deng X, Li H, Fu Z, Xu Y (2012) Clinical presentation and surgical outcome of intramedullary spinal cord cavernous malformations. J Neurosurg Spine 16(3):308–314

    Article  PubMed  Google Scholar 

  30. Liu T, Li K, Wang YL et al (2021) Treatment strategies and prognostic factors for spinal cavernous malformation: a single-center retrospective cohort study. J Neurosurg Spine 35(6):824–833

    Article  PubMed  Google Scholar 

  31. Nagoshi N, Tsuji O, Nakashima D, Takeuchi A, Kameyama K, Okada E et al (2019) Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study. J Neurosurg Spine 31(2):271–278

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Mrs Xiao Zheng, Mrs Zheling Zhao for collecting and sorting the follow-up data. Drs Hongtao Rong and Zhenying Han contributed substantially to the conception or design of the work. Drs Yongli Wang and Fanjian Li were involved in data acquisition. Drs Ye Tian, Yingsheng Wei and Jinhao Huang analyzed and interpreted the data. All authors were involved in drafting the work or revising it critically for important intellectual content, approved the final version to be published, and in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study is supported by the Young Scientists Award 82022020 from the National Natural Science Foundation of China (ZLZ), the National Natural Science Foundation of China 81971176 (ZLZ)

Author information

Author notes

  1. Tong Liu, Lichao Wang, Shizhong Zhang, Hao Han, Kangjie Du are co-first authors and contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Tianjin Institute of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road in Heping District, Tianjin, 300052, China

    Tong Liu, Xin Chen, Zilong Zhao, Liwen Zhao, Jiapeng Xie, Tao Zhu & Qiang Huang

  2. Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China

    Lichao Wang

  3. Department of Neurosurgery, The Affiliated Taian City Centeral Hospital of QingDao University, Qingdao, Shandong, China

    Shizhong Zhang

  4. Department of Neurosurgery, Jining No 1 People’s Hospital, Neurosurgery, Jining, Shandong, China

    Hao Han

  5. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China

    Kangjie Du

  6. Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China

    Lu Zhao & Zhijun Peng

Authors
  1. Tong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lichao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shizhong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hao Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kangjie Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zilong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liwen Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jiapeng Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lu Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhijun Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tao Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Qiang Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qiang Huang.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, T., Wang, L., Zhang, S. et al. Prediction of outcomes for symptomatic spinal cavernous malformation surgery: a multicenter prospective clinical study. Eur Spine J 32, 1326–1333 (2023). https://doi.org/10.1007/s00586-023-07585-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07585-9

Keywords

Search

Navigation