Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature

Clinical article

Restricted access

Object

Spinal cavernomas are rare, but can cause significant neurological deficits due to mass effect and extralesional hemorrhage. The authors present their results of microsurgical treatment of 14 consecutive patients with spinal cavernoma, and review the literature.

Methods

Of the 376 patients with cavernomas of the CNS treated at Helsinki University Central Hospital (a catchment area close to 2 million inhabitants) between January 1980 and June 2009, 14 (4%) had a spinal cavernoma. The authors reexamined and analyzed the patient files and images retrospectively. Median patient age at presentation was 45 years (range 20–57 years). The female/male ratio was equal. Median duration of symptoms before admission to the department was 12 months (range 0.1–168 months). Patients suffered from sensorimotor paresis, radicular pain, or neurogenic micturition disorders in different combinations or separately. Hemorrhage had occurred in 7 patients (50%) before surgery. In 9 patients (64%) the cavernoma was intramedullary, in 4 (29%) extradural, and in 1 intradural extramedullary. On MR imaging, 6 patients (43%) had a cavernoma in the cervical region, 7 (50%) in the thoracic region, and 1 (7%) in the lumbar region.

Results

Postoperatively, patients were followed up for a median of 3 years (range 1–10 years). At follow-up, 13 patients (93%) experienced significant improvement in motor ability after surgery, and all patients were able to walk with or without aid. Ten of the 11 patients with pain syndrome (91%) showed significant pain relief without recurrence. Micturition disorder was noted in 6 patients (43%) at follow-up, but in 5 the condition had existed before surgery. No patient improved in bladder function after surgery, and 1 patient developed micturition dysfunction postoperatively.

Conclusions

Microsurgical removal of spinal cavernomas alleviates sensorimotor deficits and pain caused by mass effect and hemorrhage. However, bladder dysfunction remains unchanged after surgery.

Article Information

Contributor Notes

Address correspondence to: Juri Kivelev, M.D., Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, Finland 00260. email: juri.kivelev@hus.fi.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Akiyama MGinsberg HJMunoz D: Spinal epidural cavernous hemangioma in an HIV-positive patient. Spine J 9:e6e82009

  • 2

    Anson JASpetzler RF: Surgical resection of intramedullary spinal cord cavernous malformations. J Neurosurg 78:4464511993

  • 3

    Appiah GAKnuckey NWRobbins PD: Extradural spinal cavernous haemangioma: case report and review of the literature. J Clin Neurosci 8:1761792001

    • Search Google Scholar
    • Export Citation
  • 4

    Bakir ASavas AYilmaz ESavaş BErden ECağlar S: Spinal intradural-intramedullary cavernous malformation. Case report and literature review. Pediatr Neurosurg 42:35372006

    • Search Google Scholar
    • Export Citation
  • 5

    Barnwell SLDowd CFDavis RLEdwards MSGutin PHWilson CB: Cryptic vascular malformations of the spinal cord: diagnosis by magnetic resonance imaging and outcome of surgery. J Neurosurg 72:4034071990

    • Search Google Scholar
    • Export Citation
  • 6

    Barrena MRGuelbenzu SMayayo-Sinues ERivero-Celada DFayed-Miquel NGómez-Perun J: [A clinico radiological study of patients with cavernous angiomas of the spinal cord.]. Rev Neurol 37:172003. (Span)

    • Search Google Scholar
    • Export Citation
  • 7

    Bian LGBertalanffy HSun QFShen JK: Intramedullary cavernous malformations: clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 111:5115172009

    • Search Google Scholar
    • Export Citation
  • 8

    Bicknell JMCarlow TJKornfeld MStovring JTurner P: Familial cavernous angiomas. Arch Neurol 35:7467491978

  • 9

    Biluts HMunie T: Intramedullary cavernous haemangioma of spinal cord: a case report and literature review. Ethiop Med J 44:2872902006

    • Search Google Scholar
    • Export Citation
  • 10

    Bruni PMassari AGreco RHernandez ROddi GChiappetta F: Subarachnoid hemorrhage from cavernous angioma of the cauda equina: case report. Surg Neurol 41:2262291994

    • Search Google Scholar
    • Export Citation
  • 11

    Canavero S: Intramedullary cavernous angiomas of the spinal cord: clinical presentation, pathological features, and surgical management. Neurosurgery 32:6926931993

    • Search Google Scholar
    • Export Citation
  • 12

    Cansever TCivelek ESencer AKarasu AKiriş THepgül K: Spinal cavernous malformations: a report of 5 cases. Surg Neurol 69:6026072008

    • Search Google Scholar
    • Export Citation
  • 13

    Cantore GDelfini RCervoni LInnocenzi GOrlando ER: Intramedullary cavernous angiomas of the spinal cord: report of six cases. Surg Neurol 43:4484521995

    • Search Google Scholar
    • Export Citation
  • 14

    Chabert EMorandi XCarney MPRiffaud LLouail CCarsin-Nicol B: Intramedullary cavernous malformations. J Neuroradiol 26:2622681999

    • Search Google Scholar
    • Export Citation
  • 15

    Che XMXu QWShou JJGu SXZhang MGSun B: [The diagnosis and surgical management for intramedullary spinal cord cavernous angioma.]. Zhonghua Yi Xue Za Zhi 88:130613082008. (Chinese)

    • Search Google Scholar
    • Export Citation
  • 16

    Cosgrove GRBertrand GFontaine SRobitaille YMelanson D: Cavernous angiomas of the spinal cord. J Neurosurg 68:31361988

  • 17

    Cristante LHermann HD: Radical excision of intramedullary cavernous angiomas. Neurosurgery 43:4244311998

  • 18

    D'Andrea GRamundo OETrillò GRoperto RIsidori AFerrante L: Dorsal foramenal extraosseous epidural cavernous hemangioma. Neurosurg Rev 26:2922962003

    • Search Google Scholar
    • Export Citation
  • 19

    Deutsch HJallo GIFaktorovich AEpstein F: Spinal intramedullary cavernoma: clinical presentation and surgical outcome. J Neurosurg 93:1 Suppl65702000

    • Search Google Scholar
    • Export Citation
  • 20

    Doyle PMAbou-Zeid ADu Plessis DHerwadkar AGnanalingham KK: Dumbbell-shaped intrathoracic-extradural haemangioma of the thoracic spine. Br J Neurosurg 22:2993002008

    • Search Google Scholar
    • Export Citation
  • 21

    Duke BJLevy ASLillehei KO: Cavernous angiomas of the cauda equina: case report and review of the literature. Surg Neurol 50:4424451998

    • Search Google Scholar
    • Export Citation
  • 22

    Enomoto HGoto H: Spinal epidural cavernous angioma. MRI finding Neuroradiology 33:4621991

  • 23

    Fazi SMenei PMercier PDubas FGuy G: Cavernomas of the spinal cord: report of two patients. Br J Neurosurg 6:1491521992

  • 24

    Feng JXu YKLi LYang RMYe XHZhang N: MRI diagnosis and preoperative evaluation for pure epidural cavernous hemangiomas. Neuroradiology 51:7417472009

    • Search Google Scholar
    • Export Citation
  • 25

    Fritzsche EFlitsch JKucinski TLund GKPapavero LWestphal M: Diagnosis and treatment of an intramedullary cavernoma in a young male with an implanted cardiac pacemaker. Acta Neurochir (Wien) 148:121312152006

    • Search Google Scholar
    • Export Citation
  • 26

    Furuya KSasaki TSuzuki IKim PSaito NKirino T: Intramedullary angiographically occult vascular malformations of the spinal cord. Neurosurgery 39:112311321996

    • Search Google Scholar
    • Export Citation
  • 27

    Gordon CRCrockard HASymon L: Surgical management of spinal cord cavernoma. Br J Neurosurg 9:4594641995

  • 28

    Goyal ASingh AKGupta VTatke M: Spinal epidural cavernous haemangioma: a case report and review of literature. Spinal Cord 40:2002022002

    • Search Google Scholar
    • Export Citation
  • 29

    Graziani NBouillot PFigarella-Branger DDufour HPeragut JCGrisoli F: Cavernous angiomas and arteriovenous malformations of the spinal epidural space: report of 11 cases. Neurosurgery 35:8568641994

    • Search Google Scholar
    • Export Citation
  • 30

    Harrington JF JrKhan AGrunnet M: Spinal epidural cavernous angioma presenting as a lumbar radiculopathy with analysis of magnetic resonance imaging characteristics: case report. Neurosurgery 36:5815841995

    • Search Google Scholar
    • Export Citation
  • 31

    Harrison MJEisenberg MBUllman JSOppenheim JSCamins MBPost KD: Symptomatic cavernous malformations affecting the spine and spinal cord. Neurosurgery 37:1952051995

    • Search Google Scholar
    • Export Citation
  • 32

    Hatiboglu MAIplikcioglu ACOzcan D: Epidural spinal cavernous hemangioma. Neurol Med Chir (Tokyo) 46:4554582006

  • 33

    Hillman JBynke O: Solitary extradural cavernous hemangiomas in the spinal canal. Report of five cases. Surg Neurol 36:19241991

  • 34

    Iglesias SAyerbe JSarasa JLSousa PTorres CRuiz-Barnés P: [Dumbbell-shaped spinal epidural cavernous angioma. Case report and review of the literature.]. Neurocirugia (Astur) 19:2482532008. (Span)

    • Search Google Scholar
    • Export Citation
  • 35

    Isla AAlvarez FMorales CGarcía Blazquez M: Spinal epidural hemangiomas. J Neurosurg Sci 37:39421993

  • 36

    Jallo GIFreed DZareck MEpstein FKothbauer KF: Clinical presentation and optimal management for intramedullary cavernous malformations. Neurosurg Focus 21:1e102006

    • Search Google Scholar
    • Export Citation
  • 37

    Jellinger KPathology of spinal vascular malformations and vascular tumors. Pia HWDjindjian R: Spinal Angiomas: Advances in Diagnosis and Therapy BerlinSpringer1978

    • Search Google Scholar
    • Export Citation
  • 38

    Kharkar SShuck JConway JRigamonti D: The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 60:8658722007

    • Search Google Scholar
    • Export Citation
  • 39

    Kim LJKlopfenstein JDZabramski JMSonntag VKSpetzler RF: Analysis of pain resolution after surgical resection of intramedullary spinal cord cavernous malformations. Neurosurgery 58:1061112006

    • Search Google Scholar
    • Export Citation
  • 40

    Kitahara TMiyasaka YOhwada TYada KMera H: [An operated case of cervical spontaneous hematomyelia.]. No Shinkei Geka 10:6756791982. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 41

    Kivelev JRamsey CNDashti RPorras MTyyninen OHernesniemi J: Cervical intradural extramedullary cavernoma presenting with isolated intramedullary hemorrhage. J Neurosurg Spine 8:88912008

    • Search Google Scholar
    • Export Citation
  • 42

    Kondziella DBrodersen PLaursen HHansen K: Cavernous hemangioma of the spinal cord—conservative or operative management?. Acta Neurol Scand 114:2872902006

    • Search Google Scholar
    • Export Citation
  • 43

    Labauge PBouly SParker FGallas SEmery ELoiseau H: Outcome in 53 patients with spinal cord cavernomas. Surg Neurol 70:1761812008

    • Search Google Scholar
    • Export Citation
  • 44

    Lee JPWang ADWai YYHo YS: Spinal extradural cavernous hemangioma. Surg Neurol 34:3453511990

  • 45

    Lopate GBlack JTGrubb RL Jr: Cavernous hemangioma of the spinal cord: report of 2 unusual cases. Neurology 40:179117931990

  • 46

    Lunardi PAcqui MFerrante LFortuna A: The role of intraoperative ultrasound imaging in the surgical removal of intramedullary cavernous angiomas. Neurosurgery 34:5205231994

    • Search Google Scholar
    • Export Citation
  • 47

    McCormick WFPathology of vascular malformations of the brain. Wilson CBStein BM: Intracranial Arteriovenous Malformations BaltimoreWilliams & Wilkins1984

    • Search Google Scholar
    • Export Citation
  • 48

    McCormick PCMichelsen WJPost KDCarmel PWStein BM: Cavernous malformations of the spinal cord. Neurosurgery 23:4594631988

  • 49

    Mehdorn HMStolke D: Cervical intramedullary cavernous angioma with MRI-proven haemorrhages. J Neurol 238:4204261991

  • 50

    Morioka TNakagaki HMatsushima THasuo K: Dumbbell-shaped spinal epidural cavernous angioma. Surg Neurol 25:1421441986

  • 51

    Nagib MGO'Fallon MT: Intramedullary cavernous angiomas of the spinal cord in the pediatric age group: a pediatric series. Pediatr Neurosurg 36:57632002

    • Search Google Scholar
    • Export Citation
  • 52

    Nishikawa MOhata KIshibashi KTakami TGoto THara M: The anterolateral partial vertebrectomy approach for ventrally located cervical intramedullary cavernous angiomas. Neurosurgery 59:1 SupplONS58ONS632006

    • Search Google Scholar
    • Export Citation
  • 53

    Nonogaki YIshii MOda NNagashima C: [Coexistence of intracranial and spinal cavernous angiomas: case report.]. No Shinkei Geka 20:127712811992. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 54

    Ogilvy CSLouis DNOjemann RG: Intramedullary cavernous angiomas of the spinal cord: clinical presentation, pathological features, and surgical management. Neurosurgery 31:2192301992

    • Search Google Scholar
    • Export Citation
  • 55

    Padovani RAcciarri NGiulioni MPantieri RFoschini MP: Cavernous angiomas of the spinal district: surgical treatment of 11 patients. Eur Spine J 6:2983031997

    • Search Google Scholar
    • Export Citation
  • 56

    Padovani RTognetti FProietti DPozzati EServadei F: Extrathecal cavernous hemangioma. Surg Neurol 18:4634651982

  • 57

    Pagni CACanavero SForni M: Report of a cavernoma of the cauda equina and review of the literature. Surg Neurol 33:1241311990

  • 58

    Rao GPBhaskar GHemaratnan ASrinivas TV: Spinal intradural extramedullary cavernous angiomas: report of four cases and review of the literature. Br J Neurosurg 11:2282321997

    • Search Google Scholar
    • Export Citation
  • 59

    Richardson RRCerullo LJ: Spinal epidural cavernous hemangioma. Surg Neurol 12:2662681979

  • 60

    Rutka JTBrant-Zawadzki MWilson CBRosenblum ML: Familial cavernous malformations. Diagnostic potential of magnetic resonance imaging. Surg Neurol 29:4674741988

    • Search Google Scholar
    • Export Citation
  • 61

    Sandalcioglu IEWiedemayer HGasser TAsgari SEngelhorn TStolke D: Intramedullary spinal cord cavernous malformations: clinical features and risk of hemorrhage. Neurosurg Rev 26:2532562003

    • Search Google Scholar
    • Export Citation
  • 62

    Santoro APiccirilli MBristot Rdi Norcia VSalvati MDelfini R: Extradural spinal cavernous angiomas: report of seven cases. Neurosurg Rev 28:3133192005

    • Search Google Scholar
    • Export Citation
  • 63

    Santoro APiccirilli MFrati ASalvati MInnocenzi GRicci G: Intramedullary spinal cord cavernous malformations: report of ten new cases. Neurosurg Rev 27:93982004

    • Search Google Scholar
    • Export Citation
  • 64

    Saringer WNöbauer IHaberler CUngersböck K: Extraforaminal, thoracic, epidural cavernous haemangioma: case report with analysis of magnetic resonance imaging characteristics and review of the literature. Acta Neurochir (Wien) 143:129312972001

    • Search Google Scholar
    • Export Citation
  • 65

    Satpathy DKDas SDas BS: Spinal epidural cavernous hemangioma with myelopathy: a rare lesion. Neurol India 57:88902009

  • 66

    Singh RVSuys SCampbell DABroome JC: Spinal extradural cavernous angioma. Br J Neurosurg 7:79811993

  • 67

    Spetzger UGilsbach JMBertalanffy H: Cavernous angiomas of the spinal cord clinical presentation, surgical strategy, and postoperative results. Acta Neurochir (Wien) 134:2002061995

    • Search Google Scholar
    • Export Citation
  • 68

    Stone JLLichtor TRuge JR: Cavernous angioma of the upper cervical spinal cord. A case report. Spine 20:120512071995

  • 69

    Tekkök IHAkpinar GGüngen Y: Extradural lumbosacral cavernous hemangioma. Eur Spine J 13:4694732004

  • 70

    Thomé CZevgaridis DMatejic DSommer CKrauss JK: Juxtaposition of an epidural intraforaminal cavernous hemangioma and an intradural schwannoma. Spine 29:E524E5272004

    • Search Google Scholar
    • Export Citation
  • 71

    Tu YKLiu HMChen SJLin SM: Intramedullary cavernous haemangiomas: clinical features, imaging diagnosis, surgical resection and outcome. J Clin Neurosci 6:2122161999

    • Search Google Scholar
    • Export Citation
  • 72

    Turjman FJoly DMonnet OFaure CDoyon DFroment JC: MRI of intramedullary cavernous haemangiomas. Neuroradiology 37:2973021995

    • Search Google Scholar
    • Export Citation
  • 73

    Tyndel FJBilbao JMHudson ARColapinto EV: Hemangioma calcificans of the spinal cord. Can J Neurol Sci 12:3213221985

  • 74

    Ueda SSaito AInomori SKim I: Cavernous angioma of the cauda equina producing subarachnoid hemorrhage. Case report. J Neurosurg 66:1341361987

    • Search Google Scholar
    • Export Citation
  • 75

    Vaquero JMartínez RMartínez P: Cavernomas of the spinal cord: report of two cases. Neurosurgery 22:1431441988

  • 76

    Villani RMArienta CCaroli M: Cavernous angiomas of the central nervous system. J Neurosurg Sci 33:2292521989

  • 77

    Vishteh AGSankhla SAnson JAZabramski JMSpetzler RF: Surgical resection of intramedullary spinal cord cavernous malformations: delayed complications, long-term outcomes, and association with cryptic venous malformations. Neurosurgery 41:109411011997

    • Search Google Scholar
    • Export Citation
  • 78

    Wang AMMorris JHFischer EGPeterson RLin JC: Cavernous hemangioma of the thoracic spinal cord. Neuroradiology 30:2612641988

  • 79

    Zentner JHassler WGawehn JSchroth G: Intramedullary cavernous angiomas. Surg Neurol 31:64681989

  • 80

    Zevgaridis DBüttner AWeis SHamburger CReulen HJ: Spinal epidural cavernous hemangiomas. Report of three cases and review of the literature. J Neurosurg 88:9039081998

    • Search Google Scholar
    • Export Citation
  • 81

    Zevgaridis DMedele RJHamburger CSteiger HJReulen HJ: Cavernous haemangiomas of the spinal cord. A review of 117 cases. Acta Neurochir (Wien) 141:2372451999

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 270 268 80
Full Text Views 130 93 2
PDF Downloads 110 58 0
EPUB Downloads 0 0 0
PubMed
Google Scholar