Abstract
Background
There have been numerous studies on the outcomes of surgery for spinal cord cavernous angiomas. However, the natural history of conservatively treated disease is not well known. The aim of this retrospective study was to investigate the outcomes of conservatively managed patients with spinal cord cavernous angioma to determine the appropriate treatment strategies.
Methods
Twenty-four patients who visited a single institution over an 11-year period and who were treated conservatively were enrolled in this study. Their medical records and radiological images were reviewed retrospectively. The neurologic status of the patients was assessed using the Japanese Orthopedic Association scoring system and the clinical presentation of the patients was classified into the following 4 categories: type A, asymptomatic; B, pain only; C, sensory deficits; and D, sensory and motor deficits. The results of types C and D patients were compared with the results of previously reported surgical series from our institution.
Results
The mean age of the enrolled patients was 52.0 years (21–73). The mean duration of the clinical follow-up was 60.5 months (11–119) and the follow-up using magnetic resonance imaging was 52.4 months (3–122). Cavernous angiomas presented in the cervical spinal cord in 12 patients, thoracic spinal cord in 10 patients and in multiple levels of the spinal cord in 2 patients. There were 5, 5, 7, and 7 patients, respectively, classified with types A, B, C, and D for clinical presentations. The rate of recurrent hemorrhage was 1.7 %/patient-year and all recurrent hemorrhages only developed in type C or D patients. In types C and D patients, improvement in the JOA score during the follow-up period was 0.77 ± 1.8 in the conservative group and 1.07 ± 1.8 in the surgical group (p = 0.500). However, improvement in the JOA sensory score after surgical treatment was statistically significant (P = 0.007).
Conclusions
Conservative treatment may be a reasonable treatment strategy for patients with types A and B. If patients present with type C or D, surgical treatment is recommended considering the better improvements in sensory deficits and the high rate of recurrent hemorrhage in such patients.
Similar content being viewed by others
References
Anson JA, Spetzler RF (1993) Surgical resection of intramedullary spinal cord cavernous malformations. J Neurosurg 78:446–451
Barnwell SL, Dowd CF, Davis RL, Edwards MS, Gutin PH, Wilson CB (1990) Cryptic vascular malformations of the spinal cord: diagnosis by magnetic resonance imaging and outcome of surgery. J Neurosurg 72:403–407
Bian LG, Bertalanffy H, Sun QF, Shen JK (2009) Intramedullary cavernous malformations: clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 111:511–517
Canavero S, Pagni CA, Duca S, Bradac GB (1994) Spinal intramedullary cavernous angiomas: a literature meta-analysis. Surg Neurol 41:381–388
Choi GH, Kim KN, Lee S, Ji GY, Oh JK, Kim TY, Yoon do H, Ha Y, Yi S, Shin H (2011) The clinical features and surgical outcomes of patients with intramedullary spinal cord cavernous malformations. Acta Neurochir (Wien) 153:1677–1684, discussion 1685
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 104:376–381
Deutsch H (2010) Pain outcomes after surgery in patients with intramedullary spinal cord cavernous malformations. Neurosurg Focus 29:E15
Gross BA, Du R, Popp AJ, Day AL (2010) Intramedullary spinal cord cavernous malformations. Neurosurg Focus 29:E14
Kharkar S, Shuck J, Conway J, Rigamonti D (2007) The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 60:865–872, discussion 865–872
Kim LJ, Klopfenstein JD, Zabramski JM, Sonntag VK, Spetzler RF (2006) Analysis of pain resolution after surgical resection of intramedullary spinal cord cavernous malformations. Neurosurgery 58:106–111, discussion 106–111
Liang JT, Bao YH, Zhang HQ, Huo LR, Wang ZY, Ling F (2011) Management and prognosis of symptomatic patients with intramedullary spinal cord cavernoma: clinical article. J Neurosurg Spine 15:447–456
Ogilvy CS, Louis DN, Ojemann RG (1992) Intramedullary cavernous angiomas of the spinal cord: clinical presentation, pathological features, and surgical management. Neurosurgery 31:219–229, discussion 229–230
Okada K, Shirasaki N, Hayashi H, Oka S, Hosoya T (1991) Treatment of cervical spondylotic myelopathy by enlargement of the spinal canal anteriorly, followed by arthrodesis. J Bone Joint Surg Am 73:352–364
Park SB, Jahng TA, Chung CK (2009) The clinical outcomes after complete surgical resection of intramedullary cavernous angiomas: changes in motor and sensory symptoms. Spinal Cord 47:128–133
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 26:253–256
Steiger HJ, Turowski B, Hanggi 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:E13
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) 141:237–245
Acknowledgements
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Education, Science and Technology) (2012–0000996)
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, K.M., Chung, C.K., Huh, W. et al. Clinical outcomes of conservative management of spinal cord cavernous angiomas. Acta Neurochir 155, 1209–1214 (2013). https://doi.org/10.1007/s00701-013-1760-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-013-1760-7