Cristante L, Hermann H D
Section of Neurosurgery, University of Manitoba Medical School, Winnipeg, Canada.
Neurosurgery. 1998 Sep;43(3):424-30; discussion 430-1. doi: 10.1097/00006123-199809000-00014.
This is a retrospective study of patients with surgically treated, intramedullary cavernous malformations. We conducted the study to elucidate the outcomes of the patients, as well as potential pitfalls in their care.
A series of 12 patients underwent radical excision of intramedullary cavernous malformations between 1986 and 1996. All lesions were diagnosed by magnetic resonance imaging. Although seven patients experienced recurrent episodes of pain and sensorimotor disturbances, the histories of the other five patients were relevant for slowly progressing deficits (mostly sensory).
All cavernomas were completely resected. No deaths were recorded. In follow-up examinations (5-102 mo after discharge), there was no evidence of recurrence, either clinically or in control magnetic resonance imaging scans. In follow-up examinations, two patients demonstrated sensory deficits that were slightly more pronounced than the preoperative deficits. The postoperative neurological status of 3 of 12 patients was unchanged, compared with the preoperative status. The status of the remaining seven patients had improved. For four patients there was effective functional improvement, and for three others there was complete postoperative relief of pain. Deficits of the long tracts were less prone to recover.
The clinical course of cavernous malformations may be difficult to distinguish from that of spinal dural arteriovenous malformations or focal demyelinating disease. In the latter case, even magnetic resonance imaging results could be deceptive. Radical resection of these malformations is feasible, with relatively low surgical morbidity, provided that the preoperative deficits of the patients are limited. Given the generally progressive course of the illness and the few acute catastrophic myelopathies, complete excision is advocated whenever malformations are symptomatic.
这是一项对接受手术治疗的髓内海绵状血管畸形患者的回顾性研究。我们开展这项研究以阐明患者的治疗结果以及治疗过程中可能存在的问题。
1986年至1996年间，一系列12例患者接受了髓内海绵状血管畸形的根治性切除。所有病变均通过磁共振成像诊断。虽然7例患者经历了疼痛和感觉运动障碍的反复发作，但其他5例患者的病史与缓慢进展的功能缺损（主要是感觉方面）相关。
所有海绵状血管瘤均被完全切除。无死亡记录。在随访检查中（出院后5 - 102个月），无论是临床检查还是磁共振成像复查，均未发现复发迹象。随访检查中，2例患者的感觉功能缺损比术前略加重。12例患者中有3例术后神经状态与术前相比无变化。其余7例患者的状态有所改善。4例患者功能有效改善，另外3例患者术后疼痛完全缓解。长束功能缺损较难恢复。
海绵状血管畸形的临床病程可能难以与硬脊膜动静脉畸形或局灶性脱髓鞘疾病相区分。在后一种情况下，即使磁共振成像结果也可能具有误导性。只要患者术前功能缺损有限，对这些畸形进行根治性切除是可行的，手术发病率相对较低。鉴于该疾病通常呈进行性发展且急性灾难性脊髓病较少见，只要畸形有症状，就主张进行完全切除。
