Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
Neurosurgery. 2018 Dec 1;83(6):1201-1208. doi: 10.1093/neuros/nyx610.
Intramedullary spinal cord cavernous malformations (CMs) account for 5% of all CMs in the central nervous system and 5% to 12% of all spinal cord vascular lesions, yet their optimal management is controversial.
To identify factors associated with the clinical progression of spinal cord CMs and quantify the range of surgical outcomes.
Retrospective observational cohort study of 32 patients who underwent open surgical resection for spinal CMs, the majority of which presented to a dorsal or lateral pial surface, from 1996 to 2017 at a single institution. We evaluated outcomes as clinically improved, worsened, or unchanged against preoperative baseline; Frankel and Aminoff-Logue disability grades were also calculated.
Mean age at presentation was 44.2 (range, 0.5-77 yr). Symptoms included sensory deficits (n = 26, 81%), loss of strength/coordination (n = 16, 50%), pain (n = 16, 50%), and bladder/bowel dysfunction (n = 6, 19%). Thoracic (n = 16, 50%) and cervical CMs (n = 16, 50%) were equally common, with overall mean size of 7.1 mm (range, 1-20 mm). Functional outcomes at last follow-up, compared to preoperative status for patients with >6 mo of follow-up, were improved in 6 (23%), unchanged in 19 (73%), and worsened in 1 (4%) patients. Preoperative Frankel grade and improved Frankel grade immediately following resection were strongly associated with improvement from baseline at long-term followup (P < .01).
Gross total resection of symptomatic spinal cord CMs can prevent further neurological decline. Our experience suggests excellent long-term outcomes and minimal surgical morbidity following resection.
硬脊膜内脊髓海绵状血管畸形（CMs）占中枢神经系统所有 CMs 的 5%，占所有脊髓血管病变的 5%至 12%，但其最佳治疗方法仍存在争议。
确定与脊髓 CMs 临床进展相关的因素，并量化手术结果的范围。
对 1996 年至 2017 年期间在一家机构接受开放性手术切除脊髓 CMs 的 32 例患者进行回顾性观察队列研究，这些患者中的大多数病变位于硬脊膜背侧或侧方表面。我们评估了相对于术前基线的临床改善、恶化或无变化的结果；还计算了 Frankel 和 Aminoff-Logue 残疾等级。
就诊时的平均年龄为 44.2 岁（范围，0.5-77 岁）。症状包括感觉障碍（26 例，81%）、肌力/协调性丧失（16 例，50%）、疼痛（16 例，50%）和膀胱/肠道功能障碍（6 例，19%）。胸段（16 例，50%）和颈段 CMs（16 例，50%）同样常见，总体平均大小为 7.1mm（范围，1-20mm）。在随访时间>6 个月的患者中，与术前相比，末次随访的功能结果得到改善的有 6 例（23%），无变化的有 19 例（73%），恶化的有 1 例（4%）。术前 Frankel 分级和切除后即刻改善的 Frankel 分级与长期随访时从基线改善显著相关（P<0.01）。
对有症状的脊髓 CMs 进行大体全切除可防止进一步的神经功能下降。我们的经验表明，切除后可获得良好的长期结果和最小的手术并发症。
