Department of Neurosurgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
Neurosurg Focus. 2010 Sep;29(3):E13. doi: 10.3171/2010.6.FOCUS10123.
In this study, the authors present a review of a series of 20 intramedullary spinal cord cavernous malformations (SCCMs) with particular focus on MR imaging and prognostic factors.
Between 1994 and 2009, 20 patients with SCCM were treated under the care of the senior author. The diagnosis was made in all patients after the onset of clinical symptoms. The age of the 9 men and 11 women ranged between 26 and 71 years (median 38.5 years). The duration of symptoms prior to referral ranged from 1 week to 9 years (median 6.5 months). At the time of referral, 4 patients had no significant neurological deficits, 10 patients suffered significant functional restrictions, and 6 patients presented with severe paraparesis and loss of functional strength. None of the patients had complete paraplegia. Seventeen patients underwent microsurgical removal, while 3 patients opted for conservative therapy. For the present analysis, the medical records and MR images and/or reports were reviewed. Classification of length of history, pretreatment status, MR imaging pattern, and treatment modality was done and correlated with outcome.
The cavernoma was located at the cervical level in 8 patients and between T-1 and L-1 in 12 patients. The cavernoma appeared as mainly T2 hyperintense on MR images in 7 patients, mainly T2 hypointense in 2 patients, and mixed in the remaining 10 patients. The craniocaudal extension of the core varied between 5 and 45 mm. In 2 patients with cervical cavernomas, a distinct T2 signal of the spinal cord cranial and distal to the cavernoma was seen, and in a patient with a large thoracic cavernoma, T2 extinction cranial and caudal to the cavernoma was seen as a sign of hemosiderosis. Neurological deficits improved postoperatively in 12 of the surgically treated patients, remained stable in 2, and deteriorated in 3. The 3 patients who were conservatively treated remained stable over a follow-up of 3-9 years. Postoperative improvement was seen in 5 of 7 surgical patients with a history of symptoms of 2 months or less, 5 of 6 patients with a history of 2-24 months, and in 2 of 4 patients with a history of more than 2 years. Two of the 3 patients with postoperative deterioration had a history of more than 2 years and the third a short history of 1 month.
Although a satisfactory outcome can be achieved through surgical treatment of SCCMs, some patients worsen after surgery or during the postoperative course. Long-term stability is possible in oligosymptomatic conservatively treated patients. The prevalence and pathophysiological importance of segmental spinal cord edema and hemosiderosis is incompletely understood at the present time.
本研究回顾性分析了 20 例脊髓髓内海绵状血管畸形（SCCM）患者的资料，重点分析了 MRI 表现和预后因素。
1994 年至 2009 年，共有 20 例 SCCM 患者在高级作者的治疗下接受治疗。所有患者在出现临床症状后均被确诊。9 名男性和 11 名女性患者的年龄为 26 至 71 岁（中位数 38.5 岁）。就诊前症状持续时间为 1 周至 9 年（中位数 6.5 个月）。就诊时，4 例患者无明显神经功能缺损，10 例患者有明显功能受限，6 例患者表现为严重截瘫和功能丧失。无患者完全截瘫。17 例患者接受了显微手术切除，3 例患者选择了保守治疗。目前分析中，回顾了病历和 MRI 图像和/或报告。对病史长短、治疗前状态、MR 成像模式和治疗方式进行分类，并与预后相关联。
海绵状血管畸形位于颈椎水平 8 例，T1 至 L1 水平 12 例。7 例 MRI 上主要表现为 T2 高信号，2 例主要表现为 T2 低信号，其余 10 例表现为混杂信号。核心的颅尾延伸范围为 5 至 45mm。在 2 例颈椎海绵状血管畸形患者中，可见到海绵状血管畸形颅尾端脊髓 T2 信号明显升高，在 1 例大的胸段海绵状血管畸形患者中，可见到海绵状血管畸形颅尾端 T2 信号消失，提示有含铁血黄素沉着。17 例手术治疗患者中，12 例术后神经功能缺损改善，2 例保持稳定，3 例恶化。3 例接受保守治疗的患者在随访 3 至 9 年后保持稳定。2 个月或更短病史的 7 例手术患者中有 5 例术后改善，24 个月或更短病史的 6 例患者中有 5 例术后改善，2 年以上病史的 4 例患者中有 2 例术后改善。3 例术后恶化的患者中，2 例病史超过 2 年，1 例病史 1 个月。
虽然 SCCM 患者通过手术治疗可以取得满意的效果，但部分患者术后病情恶化或术后病情加重。对于症状单一的保守治疗患者，长期稳定是可能的。目前对节段性脊髓水肿和含铁血黄素沉着的流行情况及其病理生理学意义还不完全了解。
