Cai Zheng, Hong Xinjie, Dai Wei, Zhang Zhengwei, Liang Qiang, Ding Xuehua, Sun Wei
Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Department of Pharmacology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Neurospine. 2023 Sep;20(3):810-821. doi: 10.14245/ns.2346430.215. Epub 2023 Sep 30.
Intramedullary spinal cavernous malformations (ISCMs) are rare vascular lesions of the spinal cord with unclear natural history and controversy over treatment. This study aimed to report a series of symptomatic ISCMs underwent microsurgical management to illustrate the natural history, clinical presentation, and surgical outcomes and to evaluate factors associated with hemorrhage events and neurological prognosis.
This single-center retrospective study included 29 consecutive patients with whose demographic, symptomology, imaging, neurological, and surgical data were collected. The risk for hemorrhage events and factors affecting surgical outcomes were retrospectively analyzed.
There were 12 female (41.4%) and 17 male patients (58.6%), with an average age of 45.2 years (range, 17-69 years). The mean size of the lesion was 9.7 mm (range, 3-20 mm). Most patients had a bowel or/and bladder dysfunction symptom (n = 11, 37.9%), followed by sensory deficits (n = 5, 17.2%), gait disturbance (n = 5, 17.2%), pain (n = 4, 13.8%), and weakness (n = 4, 13.8%), most (n = 15, 51.7%) with a chronic onset. All patients received total resection without rehemorrhages after surgical resection in follow-up. Sixty-five point five percent patients (n = 19) improved, 13.8% (n = 4) remained stable, 20.7% (n = 6) got worsen. The overall annual hemorrhage risk was 2.1% per patient-year. A total of 27 hemorrhages occurred in the 18 patients, of which rehemorrhage rate increased to 50.0% (n = 9) with a previous history of hemorrhage. Patients with smaller lesion sizes were more likely to have hemorrhage or rehemorrhage events (p = 0.008). Recurrent hemorrhage of the lesions was a risk factor for neurological outcomes (p = 0.016).
The risk of rehemorrhage was significantly increased in symptomatic ISCM patients with a previous history of hemorrhage. Rehemorrhage was a risk factor for neurological outcomes. Patients can benefit from microsurgical treatment to avoid rehemorrhage and further neurological deterioration.
脊髓髓内海绵状血管畸形（ISCMs）是脊髓罕见的血管性病变，其自然病史尚不明确，治疗存在争议。本研究旨在报告一系列接受显微手术治疗的有症状ISCMs，以阐明其自然病史、临床表现和手术结果，并评估与出血事件及神经功能预后相关的因素。
这项单中心回顾性研究纳入了连续29例患者，收集了他们的人口统计学、症状学、影像学、神经功能及手术数据。对出血事件风险及影响手术结果的因素进行回顾性分析。
有12例女性患者（41.4%）和17例男性患者（58.6%），平均年龄45.2岁（范围17 - 69岁）。病变平均大小为9.7毫米（范围3 - 20毫米）。大多数患者有肠道或/和膀胱功能障碍症状（n = 11，37.9%），其次是感觉障碍（n = 5，17.2%）、步态障碍（n = 5，17.2%）、疼痛（n = 4，13.8%）和无力（n = 4，13.8%），大多数（n = 15，51.7%）为慢性起病。所有患者均接受了全切手术，术后随访未再出血。65.5%的患者（n = 19）病情改善，13.8%（n = 4）病情稳定，20.7%（n = 6）病情恶化。总体每年每位患者的出血风险为2.1%。18例患者共发生27次出血，其中有出血史的患者再出血率增至50.0%（n = 9）。病变较小的患者更易发生出血或再出血事件（p = 0.008）。病变反复出血是神经功能预后的一个危险因素（p = 0.016）。
有出血史的有症状ISCM患者再出血风险显著增加。再出血是神经功能预后的危险因素。患者可从显微手术治疗中获益，以避免再出血和进一步神经功能恶化。
