Cavernous Haemangiomas of the Spinal Cord. A Review of 117 Cases

Abstract

Intramedullary spinal cord cavernous haemangiomas are rare lesions that can cause severe myelopathic symptoms. The purpose of the present study was to define the pattern of clinical presentation, part of natural history, prognostic factors and therapeutic strategies considering both our own experience and reports from the literature. The data of 48 studies (published between 1903 and 1996), presenting information of all together 107 patients (108 lesions) regarding pre-treatment clinical and radiological factors, treatment strategies, and the outcome, plus our own experience of nine patients were retrospectively re-analyzed. The prognostic influence of pretreatment factors was estimated with the chi-square statistics. Clinical evaluation before/after treatment was performed using the Frankel scale. The average bleeding rate was obtained from the ratio of percentage of first bleeding events in the population to the mean age of the population. There were 47 males and 69 females (aged from twelve to 88 years). Thirty nine percent of the lesions were found in the cervical, 54% in the thoracic (30% upper, 24% lower) and 7% in the lumbar cord. The peak age of presentation was in the fourth decade, the median duration of symptoms was 32 months. Clinical symptoms before treatment were progressive in all cases. Three patterns of clinical presentation could be identified: a) episodes of stepwise clinical deterioration (30%), b) slow progression of neurological decline (41%), c) acute onset with rapid or gradual decline over weeks or months (26%). 58% of the lesions showed clinical or radiological signs of haemorrhage. In 66% of surgical patients (91 efficiently documented cases), clinical improvement was achieved, 28% remained unchanged and 6% deteriorated. Whereas age, sex and lesion location had no influence on the results, duration of symptoms (< three years) correlated significantly to a better outcome (p < 0.02). Surgical management in symptomatic patients is recommended. Once clinical signs caused by the malformation have appeared, the patients tend to experience progressive neurological deterioration.

The clinical outcomes after complete surgical resection of intramedullary cavernous angiomas: changes in motor and sensory symptoms

“…1 Spinal intramedullary CAs usually occur at the thoracic levels during the third and fourth decade of life, with a slight female predominance of 1.5:1. 2 The hemorrhage rate of symptomatic intramedullary CAs is 1.4-4.5% per lesion and per year.…”

“…2 The hemorrhage rate of symptomatic intramedullary CAs is 1.4-4.5% per lesion and per year. 1,3 There might be several treatment strategies in spinal intramedullary CAs. Although radiosurgery has been used in the treatment of intracranial CAs, no data exist for spinal intramedullary CAs.…”

“…4 Because the natural history of spinal intramedullary CAs is uncertain yet, surgical removal of asymptomatic spinal intramedullary CAs is still under debate. 1 However, only surgical removal of spinal intramedullary CAs in symptomatic patients provides a way to stop progression and to reduce the neurological symptoms. 1,5 In terms of surgical outcome, 66% of patients showed improvement following the removal of spinal intramedullary CAs and 28% of patients showed no change.…”

“…1 However, only surgical removal of spinal intramedullary CAs in symptomatic patients provides a way to stop progression and to reduce the neurological symptoms. 1,5 In terms of surgical outcome, 66% of patients showed improvement following the removal of spinal intramedullary CAs and 28% of patients showed no change. 1 However, long-term control or improvement in pain severity was achieved in only 50% of patients.…”

“…1,5 In terms of surgical outcome, 66% of patients showed improvement following the removal of spinal intramedullary CAs and 28% of patients showed no change. 1 However, long-term control or improvement in pain severity was achieved in only 50% of patients. 6 Most reports concerning the surgical resection of intramedullary CAs have not addressed the changes in motor and sensory symptoms separately.…”