Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece.
Department of Neurosurgery, Zentralklinik, 99438, Bad Berka, Germany.
Eur Spine J. 2022 Nov;31(11):3119-3129. doi: 10.1007/s00586-022-07332-6. Epub 2022 Aug 6.
This study aimed to investigate the neurological outcome, trends and sequelae following surgical or conservative treatment of intramedullary spinal cord cavernous malformations (ISCCMs).
A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measure was the change in the neurological status after surgery or conservative management. A logistic regression analysis investigating prognostic factors related to outcome was also performed.
Twenty-one studies with 1091 patients in total were included, of which 1005 (92.1%) underwent surgical resection and 86 (7.9%) were treated conservatively. Gross total resection was achieved in 95.7% of the patients and partial resection in 4.3%. Most lesions (60.2%) were located in the thoracic spine and presented with motor (60.4%) and sensory deficits (59.7%). In the long term, surgical treatment resulted in an improved neurological status in 36.9% of the patients, in 55.8% it remained stable, and in 7.3% it deteriorated compared to the preoperative state. In the conservative cohort, 21.7% improved, 69.6% remained stable, and 8.7% deteriorated. Solitary lesions, duration of preoperative symptoms less than 3 months as well as an improved post-operative neurological status were predictors of a favourable long-term outcome.
Whenever feasible, symptomatic patients with ISCCM are recommended to undergo surgery within 3 months from symptom onset. Absence of multiple lesions and, most importantly, post-operative symptom improvement foresee a favourable long-term outcome. Further research is warranted to discern the role of conservative treatment in symptomatic patients.
本研究旨在探讨脊髓髓内海绵状血管畸形（ISCCMs）手术或保守治疗后的神经预后、趋势和后遗症。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价。主要观察指标是手术或保守治疗后神经状态的变化。还进行了 logistic 回归分析，以调查与结果相关的预后因素。
共纳入 21 项研究，总计 1091 例患者，其中 1005 例（92.1%）接受手术切除，86 例（7.9%）接受保守治疗。95.7%的患者实现了大体全切除，4.3%实现了部分切除。大多数病变（60.2%）位于胸椎，表现为运动（60.4%）和感觉障碍（59.7%）。长期来看，手术治疗使 36.9%的患者神经功能状态得到改善，55.8%保持稳定，7.3%较术前恶化。在保守组中，21.7%的患者改善，69.6%的患者保持稳定，8.7%的患者恶化。单发病变、术前症状持续时间小于 3 个月以及术后神经功能改善是长期预后良好的预测因素。
只要可行，有症状的 ISCCM 患者建议在症状出现后 3 个月内进行手术。无多发病变，最重要的是术后症状改善，预示着长期预后良好。需要进一步研究以明确保守治疗在有症状患者中的作用。
