Clark Aaron J, Wang Doris D, Lawton Michael T
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Handb Clin Neurol. 2017;143:303-308. doi: 10.1016/B978-0-444-63640-9.00030-8.
Spinal cavernous malformations are rare intramedullary vascular lesions of the central nervous system. Most are located in the thoracic spine. Patients present with either acute neurologic deficit or gradual deterioration. Weakness is the most common presenting symptom. The annual hemorrhage risk is 2.1%. Diagnosis is made by magnetic resonance imaging as these lesions are occult on angiography. Surgical removal is indicated in patients with hemorrhage and neurologic deficit. All lesions are approached posteriorly by laminectomy. Dorsal cavernous malformations are exposed by focused laminectomy of the level or levels overlying the lesion with minimally facet violation. Ventral and lateral lesions are approached by laminectomy including a level above and level below as well as unilateral radical facetectomy. After midline dural opening, the dentate ligament is divided and retracted to allow up to 90° of rotation of the spinal cord. Microsurgical treatment is associated with 42% symptom improvement and 50% symptom stabilization. Postoperative worsening is associated with longer preoperative duration of symptoms. Therefore we recommend consideration of early surgery for cavernous malformation removal in patients with symptoms attributable to the lesion.
脊髓海绵状血管畸形是中枢神经系统罕见的髓内血管病变。大多数位于胸椎。患者表现为急性神经功能缺损或逐渐恶化。无力是最常见的首发症状。年出血风险为2.1%。诊断通过磁共振成像进行，因为这些病变在血管造影中隐匿。有出血和神经功能缺损的患者需要进行手术切除。所有病变均通过椎板切除术从后方入路。背侧海绵状血管畸形通过对病变上方一个或多个节段进行聚焦椎板切除术暴露，尽量减少对小关节的损伤。腹侧和外侧病变通过包括病变上方和下方一个节段以及单侧根治性小关节切除术的椎板切除术入路。在中线硬脊膜切开后，切断并牵开齿状韧带，使脊髓旋转可达90°。显微手术治疗可使42%的症状改善，50%的症状稳定。术后病情恶化与术前症状持续时间较长有关。因此，我们建议对有病变相关症状的患者考虑早期手术切除海绵状血管畸形。
