gms | German Medical Science

Objective: Intraspinal cavernomas are rare benign lesions, accounting for 5-12% of intramedullary tumours. They consist of dilated and sinusoidal vascular channels, and may appear sporadically or in association with a family history. They usually present with acute, progressive or recurrent neurological deficit. The present study aims (1) to analyse our surgical experience with spinal cavernomas over a period of 14 years, and (2) to identify potential prognostic factors of patients' outcome.

Method: We retrospectively analysed data of 16 consecutive patients with spinal cavernomas who were operated upon from 11/1998 until 11/2012. Median age was 47 years (range: 17-72), male/female ratio was 1. We categorized lesion localization into cervical/cervicothoracic and thoracic/thoracolumbar. Functional status was assessed using the Frankel Scale. Patients were initially followed up clinically and by MRI, and afterwards clinically.

Results: Almost all patients of our cohort presented with a preoperative Frankel Score D (93.8%), one patient (6.3%) was C. The clinical presentation was pain (n=6), sensory deficits (n=5), paresis (n=4), and myelopathy (n=4). Half of the lesions were located cervical/cervicothoracic, the other half thoracic/thoracolumbar. Seven lesions were unisegmental, 9 involved more than 1 segment. Ten patients were approached by laminoplasty, 6 older individuals by laminectomy/hemilaminectomy. Two patients required second look surgery: one developed posthemorrhagic arachnopathy that was untethered, another individual suffered from a rebleeding caused by a hypothetic recurrent cavernoma. None of the patients was discharged with a worse Frankel Score. During long-term follow-up (range 9-134 months, mean 38.2) 3 patients improved leading to an overall improvement rate of 27.3%.

Conclusions: Surgery on spinal cavernomas can be performed safely with a good neurological outcome. We could not identify prognostic factors influencing patients’ outcome. Of interest, localization and number of involved segments did not affect the outcome. We recommend surgical removal in patients with progressive neurological deficits, and in young patients due to their potentially higher cumulative risk for symptomatic hemorrhage.