Spinal cavernous malformations (SCM) are rare lesions often presenting with acute onset of symptoms and progressive neurological deterioration due to hemorrhage into the spinal cord. With the aid of modern techniques, their surgical removal became much safer. The present study was undertaken to analyze the outcome of our series of surgically and conservatively treated patients with SCM. Over a period of 20 years, 20 surgically treated and 5 conservatively managed patients with spinal cavernous malformations were identified and enrolled into this analysis. Demographic data, clinical symptoms, localization and extension of the cavernoma, as well as pre- and postoperative neurological status were obtained. The clinical status was assessed using the Frankel score. Patients were followed up clinically and by MRI. Before surgery, 90 % (18/20) of our surgical patients were classified as Frankel D (93.8 %), whereas two patients (10 %) were graded C. None of the patients had a worse Frankel score at the time of discharge. Eighty percent of them (16 cases) remained unchanged, and 20 % (4 patients) improved during the first follow-up (mean 6.3 months, range 2–17 months). All improved patients had a superficially located SCM and were operated early (≤3 months). No worsening was observed during extended follow-up (range 9–134 months, mean 44.7 months). Five nonsurgically treated patients showed no significant clinical deterioration over a period of 6.7 years (mean, range 2.9–8 years). SCM localization and number of involved segments had no influence on outcome. Our data show that SCM can be resected with favorable neurological outcome by using intraoperative neuromonitoring. Within the follow-up period, patients treated conservatively remained in a stable neurological condition.
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Oliver Bozinov, Zurich, Switzerland
The case series of Ardeshiri et al. provides an extensive single-center experience of a rare disease and concludes favorable outcome after surgery for those patients who are symptomatic and young. The clinical results are very good. Intraoperative neuromonitoring plays a significant role nowadays for these lesions, but intraoperative imaging did not in this long-term case series. Those cases, elderly or asymptomatic, which were treated conservatively by watch-and-wait remained in a stable neurological condition. These results confirm the modern understanding and current treatment regiments for spinal cavernomas, and Fig. 4 explains perfectly in a very simple way the golden strategy for this rare disease. This experienced and well-described retrospective case series is important and adds more cases to the literature. However, it is time for a prospective multicenter randomized study or a registry for such a disease where high numbers will not be achieved by a single institute. Technically, this is a straightforward surgical procedure and does not need very few specialized centers, but active institutions should combine their patient data to one (minimum) registry and achieve hopefully one profound consensus thereby.
Ardeshir Ardeshiri and Neriman Özkan contributed equally to this work.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Video material showing resection of the SCM in patient 5 (Th11). Following steps are shown: opening of the dura, myelotomy, microsurgical resection of the cavernoma, inspection of resection cavity and dural closure. (WMV 6147 kb)
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Ardeshiri, A., Özkan, N., Chen, B. et al. 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, 269–276 (2016) doi:10.1007/s10143-015-0674-7
- Cavernous malformations
- Intramedullary spinal cord tumor
- Spinal cavernomas
- Spinal surgery