Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience

Clinical article

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Object

The management of intramedullary spinal cord cavernous malformations (CMs) is controversial. At Barrow Neurological Institute, the authors selectively offer surgical treatment for symptomatic spinal cord CMs. The purpose of this paper is to review the clinical outcomes in patients after resection of these lesions based on a single-center experience over a 25-year period.

Methods

The records of 80 patients who underwent resection of pathologically confirmed spinal cord CMs from January 1985 to May 2010 were analyzed retrospectively. Preoperative clinical status and imaging findings were evaluated as well as immediate and long-term postoperative outcomes.

Results

Compared with their preoperative Frankel grade, 11% of patients were worse, 83% were the same, and 6% improved immediately after surgery. At a mean follow-up interval of 5 years, 10% of patients were worse, 68% were the same, and 23% were improved compared with their preoperative status. Five percent of patients underwent reoperation for resection of a symptomatic residual or recurrent lesion. Immediate complications were encountered in 6% of patients, including CSF leakage and deep venous thrombosis. Long-term complications were encountered in 14% of patients and included kyphotic deformity, stenosis, and spinal cord tethering. A significant correlation was found between long-term outcome and anteroposterior length of the lesion (p = 0.01).

Conclusions

The resection of intramedullary spinal cord CMs can be achieved with good long-term outcomes and an acceptable risk of immediate or delayed complications.

Abbreviations used in this paper: CM = cavernous malformation; DREZ = dorsal root entry zone.

Article Information

Current address for Dr. Vishteh: Section of Neurological Surgery, John C. Lincoln Hospital, Phoenix, Arizona.

Address correspondence to: Robert F. Spetzler, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

Please include this information when citing this paper: published online February 25, 2011; DOI: 10.3171/2011.1.SPINE10454.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Imaging of a representative patient with an intramedullary spinal cord CM. A: Sagittal T1-weighted MR image demonstrating a mixed intensity lesion behind the C-7 vertebral body consistent with an intramedullary spinal cord CM. B: Sagittal T2-weighted MR image of the same lesion. C: Axial T2-weighted MR image showing the lesion located laterally within the spinal cord. This lesion was resected through a myelotomy at the DREZ, and the lesion was extirpated with the use of a carbon dioxide laser. D: Postoperative sagittal T1-weighted MR image shows no residual lesion.

  • View in gallery

    Graph showing postoperative and long-term outcomes after resection of spinal cord CMs. Data shown as the same, better, or worse relative to preoperative neurological status.

References

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