Clinical presentation and surgical outcomes of an intramedullary C2 spinal cord cavernoma: a case report and review of the relevant literature

Abstract

Background:The spinal cord intramedullary cavernoma (SCIC) is a rare form of hemangioma that typically behaves as a space-occupying lesion resulting in neurological symptoms, including bladder and bowel dysfunction. To date, there have been few reports characterizing the clinical presentations and surgical outcomes of cavernomas at the C2 spinal level or the potential for resolution of bladder and bowel symptoms postoperatively. This case details the clinical course of a patient with a C2 cavernoma with an atypical neurological presentation and rapid improvement in both bladder and bowel function postoperatively.This case reviews the relevant literature and describes the patient's clinical presentation, radiological and pathological findings and post-surgical progress.Methods: A 56-year-old male presented with sensory changes in his right hand, which rapidly progressed over ensuing weeks to bilateral sensory changes in the upper and lower limbs, gait imbalance, urinary and faecal incontinence and loss of temperature perception. He subsequently developed significant weakness in the upper limbs. A MRI identified a hematoma in the cervical cord at the C2 level. Given his rapid neurological decline and the social and clinical implications of his bladder and bowel instability, a surgical approach to therapy was adopted.Results: Postoperatively, there was steady improvement in motor and sensory function and a complete return of bladder and bowel function.Conclusions: Intramedullary spinal cord cavernomas, although rare, can cause significant neurological deficits and morbidity. Surgical excision can provide significant benefits, including restoration of bladder and bowel function.

Intramedullary Spinal Cord Cavernoma: A Case Report and Literature Review

“…10,12 Across 23 literature studies with 825 patients, 671 CMs (81%) were totally resected. 3,7,9,[10][11][12]16,[17][18][19][24][25][26]28,29,32,34,[36][37][38][41][42][43] Transient early postoperative morbidity was reported in 15 out of 116 patients (12%) in 3 series, At the long-term followup 224 patients were improved (27.15%), 393(47.5%) were unchanged, and 72 (8.7%) were worsened, as compared with their preoperative status. These overall results are summarized in Table 2.…”

“…Outcome on surgically treated SICM 3,7,9,[10][11][12]16,[17][18][19][24][25][26]28,29,32,34,[36][37][38][41][42][43]…”

Spinal Cavernoma in an Infant: A Rare Pathological Entity with an Atypical Presentation

“…Bladder involvement occurs in about 11–35% of patients with spinal CM [8, 11]. Although Kivelev et al [11] in their adult series reported no change in the bladder function after surgery, others have shown improvement [12, 13]. In children, the rate of recovery appears to be better which is probably related to plasticity of neural tissue [4, 6, 14].…”