Lefranc F, Balériaux D, Brotchi J
Service de neurochirurgie, hôpital Erasme, université libre de Bruxelles, 808 route de Lennik, 1070 Brussels, Belgium.
Neurochirurgie. 2007 Jun;53(2-3 Pt 2):203-7. doi: 10.1016/j.neuchi.2007.02.009.
Intramedullary cavernomas are rare, but with routinely use of MRI detection has improved, raising the problem of choosing the adequate management approach: conservative or surgical. Cavernomas are vascular malformations, but, as hemangioblastomas they appear as vascular tumors of the spinal cord. They can be durably asymptomatic. The symptoms are a progressive clinical deterioration or acute spinal dysfunction (tetra or paraplegia) in case of hemorrhage. Cavernomas have a typical aspect with MRI in contrast with intramedullary gliomas. The lesion is often superficial, covered by the pia-mater, visible immediately after opening the dura, the approach is direct; but in few cases the cavernoma is deep seated in the spinal cord and not visible, the approach is through the midline. It is recommended to perform a complete "en bloc" resection. A yearly MRI control is necessary to search possible "de novo" cases.
髓内海绵状血管瘤较为罕见，但随着MRI的常规使用，其检出率有所提高，这就引发了选择适当治疗方法的问题：保守治疗还是手术治疗。海绵状血管瘤是血管畸形，但与成血管细胞瘤一样，它们表现为脊髓的血管性肿瘤。它们可以长期无症状。症状为渐进性临床恶化或出血时的急性脊髓功能障碍（四肢瘫或截瘫）。与髓内胶质瘤相比，海绵状血管瘤在MRI上有典型表现。病变通常表浅，被软脑膜覆盖，打开硬脑膜后可立即看到，手术入路直接；但在少数情况下，海绵状血管瘤位于脊髓深部且不可见，手术入路需经中线。建议进行完整的“整块”切除。每年进行MRI检查以筛查可能的“新发”病例是必要的。
