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Published in: European Spine Journal 10/2011

01-10-2011 | Original Article

Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome

Authors: Homajoun Maslehaty, Harald Barth, Athanassios K. Petridis, Alexandros Doukas, Hubertus Maximilian Mehdorn

Published in: European Spine Journal | Issue 10/2011

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Abstract

Purpose

We demonstrate clinical features, therapy and outcome of 14 patients with symptomatic spinal cavernous malformations (CM).

Methods

We retrospectively reviewed all patients who underwent microsurgical treatment of symptomatic spinal CM during the last decade in our department through an analysis of our database.

Results

We analyzed the data of 14 patients (11 females, 3 males) with symptomatic spinal CM in a range of 16–77 years (mean age 47.8 years). Seven patients (50%) experienced significant improvement of their symptoms rapidly after surgery. The remaining seven patients presented new non pre-existing complaints, which improved gradually with a favourable outcome at the last follow-up examination in six cases.

Conclusion

Microsurgical treatment under perioperative electrophysiological monitoring is justified to prevent severe neurofunctional deterioration in symptomatic spinal CM. Although some of the patients deteriorate after surgery, the symptoms are rapidly declining with a favourable outcome in majority of them.
Literature
1.
go back to reference Ahlhelm F, Hagen T, Schulte-Altedorneburg G, Grunwald I, Reith W, Roth C (2007) Cavernous malformations. Radiologe 47(10):863–867PubMedCrossRef Ahlhelm F, Hagen T, Schulte-Altedorneburg G, Grunwald I, Reith W, Roth C (2007) Cavernous malformations. Radiologe 47(10):863–867PubMedCrossRef
2.
go back to reference Awad I, Barrow D (1993) Cavernous malformations. Am Assoc Neurol Surg Awad I, Barrow D (1993) Cavernous malformations. Am Assoc Neurol Surg
3.
go back to reference Bian LG, Bertalanffy H, Sun QF, Shen JK (2009) Intramedullary cavernous malformations: clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 111(6):511–517PubMedCrossRef Bian LG, Bertalanffy H, Sun QF, Shen JK (2009) Intramedullary cavernous malformations: clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 111(6):511–517PubMedCrossRef
4.
go back to reference Canavero S, Pagni CA, Duca S, Bradac GB (1994) Spinal intramedullary cavernous angiomas: a literature meta-analysis. Surg Neurol 41(5):381–388PubMedCrossRef Canavero S, Pagni CA, Duca S, Bradac GB (1994) Spinal intramedullary cavernous angiomas: a literature meta-analysis. Surg Neurol 41(5):381–388PubMedCrossRef
5.
go back to reference Craig HD, Gunel M, Cepeda O, Johnson EW, Ptacek L, Steinberg GK, Ogilvy CS, Berg MJ, Crawford SC, Scott RM, Steichen-Gersdorf E, Sabroe R, Kennedy CTC, Mettler G, Beis MJ, Fryer A, Awad IA, Lifton RP (1998) Multilocus linkage identifies two new loci for a mendelian form of stroke, cerebral cavernous malformation, at 7p15–13 and 3q25.2–27. Hum Mol Genet 7:1851–1858PubMedCrossRef Craig HD, Gunel M, Cepeda O, Johnson EW, Ptacek L, Steinberg GK, Ogilvy CS, Berg MJ, Crawford SC, Scott RM, Steichen-Gersdorf E, Sabroe R, Kennedy CTC, Mettler G, Beis MJ, Fryer A, Awad IA, Lifton RP (1998) Multilocus linkage identifies two new loci for a mendelian form of stroke, cerebral cavernous malformation, at 7p15–13 and 3q25.2–27. Hum Mol Genet 7:1851–1858PubMedCrossRef
6.
go back to reference Deutsch H (2010) Pain outcomes after surgery in patients with intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E15PubMedCrossRef Deutsch H (2010) Pain outcomes after surgery in patients with intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E15PubMedCrossRef
7.
go back to reference Deutsch H, Jallo GI, Faktorovich A, Epstein F (2000) Spinal intramedullary cavernoma: clinical presentation and surgical outcome. J Neurosurg 93(1 Suppl):65–70PubMed Deutsch H, Jallo GI, Faktorovich A, Epstein F (2000) Spinal intramedullary cavernoma: clinical presentation and surgical outcome. J Neurosurg 93(1 Suppl):65–70PubMed
8.
go back to reference Dörner L, Buhl R, Hugo HH, Jansen O, Barth H, Mehdorn HM (2005) Unusual locations for cavernous hemangiomas: report of two cases and review of the literature. Acta Neurochir (Wien) 147(10):1091–1096 (discussion 1096)CrossRef Dörner L, Buhl R, Hugo HH, Jansen O, Barth H, Mehdorn HM (2005) Unusual locations for cavernous hemangiomas: report of two cases and review of the literature. Acta Neurochir (Wien) 147(10):1091–1096 (discussion 1096)CrossRef
9.
go back to reference Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 7:179–192PubMedCrossRef Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 7:179–192PubMedCrossRef
10.
go back to reference Ghogawala Z, Ogilvy CS (1999) Intramedullary cavernous malformations of the spinal cord. Neurosurg Clin N Am 10(1):101–111PubMed Ghogawala Z, Ogilvy CS (1999) Intramedullary cavernous malformations of the spinal cord. Neurosurg Clin N Am 10(1):101–111PubMed
11.
go back to reference Gross BA, Du R, Popp AJ, Day AL (2010) Intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E14PubMedCrossRef Gross BA, Du R, Popp AJ, Day AL (2010) Intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E14PubMedCrossRef
12.
go back to reference Guzeloglu-Kayisli O, Amankulor NM, Voorhees J, Luleci G, Lifton RP, Gunel M (2004) KRIT1/cerebral cavernous malformation 1 protein localizes to vascular endothelium, astrocytes, and pyramidal cells of the adult human cerebral cortex. Neurosurgery 54(4):943–949 (discussion 949)PubMedCrossRef Guzeloglu-Kayisli O, Amankulor NM, Voorhees J, Luleci G, Lifton RP, Gunel M (2004) KRIT1/cerebral cavernous malformation 1 protein localizes to vascular endothelium, astrocytes, and pyramidal cells of the adult human cerebral cortex. Neurosurgery 54(4):943–949 (discussion 949)PubMedCrossRef
13.
go back to reference Jones SJ, Buonamassa S, Crockard HA (2003) Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evokedpotentials. J Neurol Neurosurg Psychiatry 74:273–276PubMedCrossRef Jones SJ, Buonamassa S, Crockard HA (2003) Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evokedpotentials. J Neurol Neurosurg Psychiatry 74:273–276PubMedCrossRef
14.
go back to reference Kharkar S, Shuck J, Conway J, Rigamonti D (2007) The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 60(5):865–872 (discussion 865–872)PubMedCrossRef Kharkar S, Shuck J, Conway J, Rigamonti D (2007) The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 60(5):865–872 (discussion 865–872)PubMedCrossRef
15.
go back to reference Kivelev J, Niemelä M, Hernesniemi J (2010) Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature. J Neurosurg Spine 13(4):524–534 (review)PubMedCrossRef Kivelev J, Niemelä M, Hernesniemi J (2010) Outcome after microsurgery in 14 patients with spinal cavernomas and review of the literature. J Neurosurg Spine 13(4):524–534 (review)PubMedCrossRef
16.
go back to reference Kim LJ, Klopfenstein JD, Zabramski JM, Sonntag VK, Sptezler RF (2006) Analysis of pain resolution after surgical resection of intramedullary spinal cord cavernous malformations. Neurosurgery 1:106–111CrossRef Kim LJ, Klopfenstein JD, Zabramski JM, Sonntag VK, Sptezler RF (2006) Analysis of pain resolution after surgical resection of intramedullary spinal cord cavernous malformations. Neurosurgery 1:106–111CrossRef
17.
go back to reference Labauge P, Bouly S, Parker F, Gallas S, Emery E, Loiseau H, Lejeune JP, Lonjon M, Proust F, Boetto S, Coulbois S, Auque J, Boulliat J, French Study Group C of Spinal Cord avernomas (2008) Outcome in 53 patients with spinal cord cavernomas. Surg Neurol 70(2):176–181 (discussion 181)PubMedCrossRef Labauge P, Bouly S, Parker F, Gallas S, Emery E, Loiseau H, Lejeune JP, Lonjon M, Proust F, Boetto S, Coulbois S, Auque J, Boulliat J, French Study Group C of Spinal Cord avernomas (2008) Outcome in 53 patients with spinal cord cavernomas. Surg Neurol 70(2):176–181 (discussion 181)PubMedCrossRef
18.
go back to reference Lu DC, Lawton MT (2010) Clinical presentation and surgical management of intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E12PubMedCrossRef Lu DC, Lawton MT (2010) Clinical presentation and surgical management of intramedullary spinal cord cavernous malformations. Neurosurg Focus 29(3):E12PubMedCrossRef
19.
go back to reference Li DY, Whitehead KJ (2010) Evaluating strategies for the treatment of cerebral cavernous malformations. Stroke 41(10 Suppl):S92–S94PubMedCrossRef Li DY, Whitehead KJ (2010) Evaluating strategies for the treatment of cerebral cavernous malformations. Stroke 41(10 Suppl):S92–S94PubMedCrossRef
20.
go back to reference McCormick PC, Michelsen WJ, Post KD (1988) Cavernous malformations of the spinal cord. Neurosurgery 23:459–463PubMedCrossRef McCormick PC, Michelsen WJ, Post KD (1988) Cavernous malformations of the spinal cord. Neurosurgery 23:459–463PubMedCrossRef
21.
go back to reference Mehdorn HM, Stolke D (1991) Cervical intramedullary cavernous angioma with MRI-proven haemorrhages. J Neurol 238(8):420–426PubMedCrossRef Mehdorn HM, Stolke D (1991) Cervical intramedullary cavernous angioma with MRI-proven haemorrhages. J Neurol 238(8):420–426PubMedCrossRef
22.
go back to reference Minh NH (2005) Cervicothoracic spinal epidural cavernous hemangioma: case report and review of the literature. Surg Neurol 64(1):83–85 (discussion 85)PubMedCrossRef Minh NH (2005) Cervicothoracic spinal epidural cavernous hemangioma: case report and review of the literature. Surg Neurol 64(1):83–85 (discussion 85)PubMedCrossRef
23.
go back to reference Rigamonti D, Hadley MN, Drayer BP, Johnson PC, Hoenig-Rigamonti K, Knight JT, Spetzler RF (1988) Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319(6):343–347PubMedCrossRef Rigamonti D, Hadley MN, Drayer BP, Johnson PC, Hoenig-Rigamonti K, Knight JT, Spetzler RF (1988) Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319(6):343–347PubMedCrossRef
24.
go back to reference 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 26:253–256PubMedCrossRef 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 26:253–256PubMedCrossRef
25.
go back to reference Spetzler RF, Detwiler PW, Riina HA, Porter RW (2002) Modified classification of spinal cord vascular lesions. J Neurosurg 96(2 Suppl):145–156PubMed Spetzler RF, Detwiler PW, Riina HA, Porter RW (2002) Modified classification of spinal cord vascular lesions. J Neurosurg 96(2 Suppl):145–156PubMed
26.
go back to reference Steiger HJ, Turowski B, Hänggi 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(3):E13PubMedCrossRef Steiger HJ, Turowski B, Hänggi 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(3):E13PubMedCrossRef
27.
go back to reference Vishteh AG, Zabramski JM, Spetzler RF (1999) Patients with spinal cord cavernous malformations are at an increased risk for multiple neuraxis cavernous malformations. Neurosurgery 45(1):30–32 (discussion 33)PubMedCrossRef Vishteh AG, Zabramski JM, Spetzler RF (1999) Patients with spinal cord cavernous malformations are at an increased risk for multiple neuraxis cavernous malformations. Neurosurgery 45(1):30–32 (discussion 33)PubMedCrossRef
Metadata
Title
Symptomatic spinal cavernous malformations: indication for microsurgical treatment and outcome
Authors
Homajoun Maslehaty
Harald Barth
Athanassios K. Petridis
Alexandros Doukas
Hubertus Maximilian Mehdorn
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 10/2011
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-1898-z

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