Vishteh A G, Sankhla S, Anson J A, Zabramski J M, Spetzler R F
Division of Neurological Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neurosurgery. 1997 Nov;41(5):1094-100; discussion 1100-1. doi: 10.1097/00006123-199711000-00013.
To examine outcomes and delayed complications after the surgical resection of intramedullary spinal cord (IMSC) cavernous malformations. The association of these lesions with cryptic intraparenchymal venous malformations at surgery also was analyzed.
The records of 17 patients who underwent resection of their histologically verified IMSC cavernous malformations were analyzed. There were nine female and eight male patients (mean age, 40.1 yr). The locations of the cavernous malformations were as follows: cervical, eight; thoracic, eight; and conus medullaris, one. The mean follow-up period was 48.3 months. Immediate postoperative and long-term neurological outcomes were compared, and delayed complications were assessed.
The patients presented with radiculopathy (n = 6), myelopathy (n = 10), and conus medullaris syndrome (n = 1). Intraoperatively, 16 (94.1%) IMSC cavernous malformations were associated with cryptic venous malformations. Immediately after surgery, four (23.5%) patients worsened neurologically whereas one (5.9%) improved. At long-term follow-up, however, 10 (58.9%) patients had improved and only 1 (5.9%) remained worse. Four (23.5%) patients experienced delayed complications. Three had undergone incomplete resection and experienced subsequent hemorrhage, necessitating subsequent resection. Another patient developed radiological tethering of the thoracic spinal cord without clinical symptoms. Two of the three patients who had undergone subsequent resection developed symptomatic tethering of the cervical spinal cord. In one of the two patients, the tethering was associated with an iatrogenic cerebellar tonsillar herniation. Both patients required surgical intervention.
The frequent coexistence of IMSC cavernous malformations with cryptic venous malformations in this series indicates a need for operative vigilance to preserve these venous anomalies. Delayed complications were the result of incomplete resection. The resultant hemorrhage required reexploration, which led to tethering of the spinal cord. Most patients who underwent resection, however, had improved neurologically at long-term follow-up.
探讨髓内脊髓（IMSC）海绵状血管畸形手术切除后的疗效及延迟并发症。同时分析这些病变在手术中与隐匿性脑实质内静脉畸形的关联。
分析17例经组织学证实的IMSC海绵状血管畸形患者的手术记录。其中女性9例，男性8例（平均年龄40.1岁）。海绵状血管畸形的位置如下：颈部8例；胸部8例；圆锥部1例。平均随访期为48.3个月。比较术后即刻和长期的神经功能结果，并评估延迟并发症。
患者表现为神经根病（n = 6）、脊髓病（n = 10）和圆锥综合征（n = 1）。术中，16例（94.1%）IMSC海绵状血管畸形与隐匿性静脉畸形相关。术后即刻，4例（23.5%）患者神经功能恶化，而1例（5.9%）改善。然而，在长期随访中，10例（58.9%）患者有所改善，仅1例（5.9%）仍较差。4例（23.5%）患者出现延迟并发症。3例手术切除不完全，随后发生出血，需要再次切除。另1例患者出现胸段脊髓的影像学上的脊髓拴系，但无临床症状。3例再次切除的患者中有2例出现颈段脊髓的症状性拴系。在这2例患者中的1例中，拴系与医源性小脑扁桃体疝有关。2例患者均需要手术干预。
本系列中IMSC海绵状血管畸形与隐匿性静脉畸形频繁共存，提示手术时需要警惕以保留这些静脉异常。延迟并发症是切除不完全的结果。由此导致的出血需要再次探查，进而导致脊髓拴系。然而，大多数接受手术切除的患者在长期随访中神经功能有所改善。
