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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Microsurgical management of patients with spinal cord cavernous malformations

Meeting Abstract

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  • T. Dukatz - Klinik für Neurochirurgie der Philipps-Universität Marburg
  • N. Wahlster - Klinik für Neurochirurgie der Philipps-Universität Marburg
  • D. Kuhnt - Klinik für Neurochirurgie der Philipps-Universität Marburg
  • C. Nimsky - Klinik für Neurochirurgie der Philipps-Universität Marburg
  • L. Benes - Klinik für Neurochirurgie der Philipps-Universität Marburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.09.05

doi: 10.3205/11dgnc062, urn:nbn:de:0183-11dgnc0620

Published: April 28, 2011

© 2011 Dukatz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Cavernous malformations (CMs) account for approximately 5% of all intraspinal lesions. Treatment concepts and follow-up data for these patients are unfrequently published. The purpose of this study was to analyze our management concept in terms of surgical technique and clinical outcome in our consecutively treated patients.

Methods: From a total of over 200 surgically treated cavernomas, 17 patients could be identified with histologically diagnosed CMs in the spinal cord treated over a 13-year-period (04/1997–11/2010). A retrospective chart review and video analysis were performed for all patients. All 17 patients underwent preoperative magnetic resonance (MR) imaging studies. Patients were approached by hemilaminectomy (n=12), laminectomy (n=4), laminoplasty (n=1) followed by microsurgical resection assisted by SSEP, MEP and ultrasonography. The pre- and postoperative neurological findings were classified with the Frankel scale.

Results: Nine females and eight males (mean age 48.7 yrs) with spinal cord CMs could be diagnosed by MRI with characteristic imaging patterns. In 70.6 % the CMs were localized in the cervical and in 29.4% in the thoracic segment. The microsurgical strategy was to localize the CMs in the spinal cord and to circularly dissect the lesion by interrupting the tiny vessels entering the CM. Total removal was achieved in all 17 patients as documented in the follow-up MRI. The average follow-up period was 9.9 months. The neurological status of 10 patients improved after surgery, in 7 individuals clinical features were unchanged (Frankel C: n=1; Frankel D: n=4; Frankel E: n=12). Two patients suffered from persisting painful neuropathy after surgery. One patient experienced a thrombosis and one patient suffered a wound infection.

Conclusions: The present data demonstrate that surgical management of spinal cord cavernomas should aim for complete resection supported by intraoperative neuromonitoring and ultrasonography. Progression of neurological symptoms can be disrupted with an acceptable procedure-related morbidity.