Surgical treatment of cavernous malformation in spinal cord

Intramedullary CMs accounts for approximately 3-5% of all CMs of the CNS and 5%–12% of all spinal cord vascular lesions. The decision between conservative management and surgical treatment of intramedullary CMs is discussed controversially and the opinions diverge. The choice of microsurgical treatment of symptomatic intramedullary CMs is usually made on a case-by-case basis, considering the neurological complaints, general condition and the level of suffering of the patients as well as the surgical accessibility. Patients with spinal intramedullary CM were enrolled who treated with surgical resection in the department of neurosurgery at our single institute between March 2007 and March 2012, retrospectively. Clinical presentation was determined using the Ogilvy classification and symptoms were evaluated on the McCormick scale. Laminoplastic laminotomies were performed for 7 patients and a one level corpectomy was performed for 1 patient. Six patients (75%) had dorsally located lesions, whereas 2 patients (25%) had ventrally located lesions. Complete microsurgical resections were done in all patients. In terms of outcome as assessed according to the McCormick classification, 4 patients (50%) had stable outcome, 3 patients (37.5%) had improved outcome, and 1 patient (12.5%) had worsened outcome. Clinical presentation based on Ogilvy’s classification at presentation showed 3 cases manifested as acute episodes of stepwise neurological deterioration (class 1), 1 case as slow progression of neurological deterioration (class 2), and 4 cases as acute onset of neurological deterioration with rapid decline (class 3). Four patients had history of acute bleeding within 1 month before surgery and 3 patients (75%) among those 4 patients clinically presented Ogilvy class 3. In Group I (early resection), the average McCormick classification at follow-up was 3.25±0.5, which was clinically improved compared with 3.0±0.8 before surgery. However, this was not statistically significant (p > 0.05). In Group II (delayed resection), the average McCormick classification at follow-up was 2.5±0.5, which was statistically improved compared with 1.5±0.5 before surgery (p < 0.05). The average preoperative VAS score for pain was 7.8±1.5 (range 5-9). VAS score was improved up to 2.5±1.3 right after the surgery and well maintained until final follow-up (2.6±1.4). The average VAS scores at immediate postoperative and follow-up were statistically improved compared preoperative VAS score (p <0.05). The principal feasibility of surgical treatment has been accepted to complete resection because recurrent episodes of bleeding raise the risk for neurological deterioration and surgery for satisfaction of long-term results. Nevertheless limitation of small number of cases, our study had reviewed considerations of surgery for CM. We suggest that a full understanding of clinical manifestations, optimal surgical timing and complete resection of intramedullary CM can guide to make a favorable clinical outcome.

Author dc:creator

• 이, 철규

Contributors dc:contributor

• 윤, 수한
• 대학원 의학과
• 106378

• Cavernous malformation
• Intramedullary
• Cavernous angioma

Language dc:language

en

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000016073
000000016073

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10900