Harrison M J, Eisenberg M B, Ullman J S, Oppenheim J S, Camins M B, Post K D
Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
Neurosurgery. 1995 Aug;37(2):195-204; discussion 204-5. doi: 10.1227/00006123-199508000-00002.
Ten cases of symptomatic cavernous malformations affecting the spine and spinal cord were retrospectively reviewed. The cases display a spectrum of pathological findings involving the vertebral body, vertebral body with epidural extension, epidural space without bony involvement, intradural extramedullary space, and intramedullary lesions. Lesions at all locations are identical histologically, electron microscopically, and immunohistochemically. This perspective, in which cavernous malformations are envisioned as a single entity arising at numerous locations, runs contrary to the view found in the neurosurgical literature. In most discussions of cavernous malformations, vertebral body lesions are depicted as separate entities from intradural lesions. Cavernous malformations, also called cavernous hemangiomas, are developmental vascular hamartomas that, by definition, do not grow by mitotic activity. Yet, the expansion of these lesions is well documented both in the literature and among our cases. The therapeutic modalities used in our series included observation, embolization, radiation, and surgical resection alone or in combination. All modalities are effective but must be tailored to the specific needs and condition of the patient. The embryology, methods of treatment, and proposed mechanisms of growth, plus similarities and differences between cavernous malformations at each location, are reviewed. Analogies between spinal and intracranial lesions are presented. On the basis of this series and a review of the literature, we conclude that cavernous malformations represent a single entity regardless of location. Segregation based on location, as is prevalent throughout the neurosurgical literature, hinders an overall understanding of these lesions. Cavernous malformations are more appropriately viewed as a single pathological entity arising in a multitude of locations. The difficulties encountered when managing cavernous malformations at various locations are unique to the location and not the lesion.
对10例有症状的累及脊柱和脊髓的海绵状畸形病例进行了回顾性研究。这些病例呈现出一系列病理表现，包括椎体、椎体伴硬膜外扩展、无骨质受累的硬膜外间隙、硬脊膜下髓外间隙和髓内病变。所有部位的病变在组织学、电子显微镜和免疫组织化学方面均相同。这种将海绵状畸形视为在多个部位出现的单一实体的观点，与神经外科文献中的观点相反。在大多数关于海绵状畸形的讨论中，椎体病变被描述为与硬脊膜内病变不同的实体。海绵状畸形，也称为海绵状血管瘤，是发育性血管错构瘤，根据定义，不会通过有丝分裂活动生长。然而，这些病变的扩大在文献和我们的病例中都有充分记录。我们系列中使用的治疗方式包括观察、栓塞、放疗以及单独或联合手术切除。所有治疗方式都是有效的，但必须根据患者的具体需求和病情进行调整。本文回顾了其胚胎学、治疗方法、推测的生长机制，以及每个部位海绵状畸形之间的异同。还介绍了脊柱和颅内病变之间的相似之处。基于本系列研究和文献回顾，我们得出结论，无论位于何处，海绵状畸形都代表一个单一实体。如神经外科文献中普遍存在的那样，基于位置进行区分阻碍了对这些病变的全面理解。海绵状畸形更适合被视为在多个部位出现的单一病理实体。在处理不同部位的海绵状畸形时遇到的困难是该部位特有的，而非病变本身特有的。
