Lateral Myelotomy for Resection of a Ruptured Intramedullary Cervico-Thoracic Cavernous Malformation

Ginalis, Elizabeth E.; Herschman, Yehuda; Patel, Nitesh V; Jumah, Fareed; Xiong, Zhenggang; Hanft, Simon

doi:10.1093/ons/opaa417

Cited by 2 publications

(1 citation statement)

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“…For intramedullary ventrolateral deep lesion, Ren adopted a new surgical approach, the dorsal root entry zone myelotomy (DREZ), and showed that of 10 patients, two (20%) patients improved and eight (80%) patients were stable after the new approach ( 30 ). Ginalis reported a multi-segment, hemorrhagic intramedullary cavernous malformation from C7 to T3 was resected through a lateral myelotomy approach at the site of superficial hemorrhage ( 31 ). As we believe, the reason for DREZ or a lateral myelotomy approach being chosen, is because the corridor is the closest way into the lesion.…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Outcome in a Cohort of 52 Patients With Symptomatic Intramedullary Spinal Cavernous Hemangioma After Microsurgery and Emergency Rescue Surgery

et al. 2022

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BackgroundSurgery is the mainstay treatment for patients with symptomatic intramedullary spinal cavernous hemangioma (ISCH), however the time of surgical intervention remains controversial. In this study, we proposed emergency rescue surgery (ERS) for patients in deteriorative type. The prognostic factors of patients with ISCH after microsurgery and the clinical effect of ERS were analyzed.MethodsFrom January 2013 to November 2019, 52 patients with symptomatic ISCH treated by microsurgical treatment were collected, ranging in age from 17 to 66 years old (mean: 45.8 ± 13.5 years). The course of the disease ranged from 2 days to 20 years. Of 52 lesions, 17 lesions were in the cervical segment, 25 in the thoracic segment, and 10 in the lumbosacral segment; while seven cases were at the ventral surface, 25 cases at the dorsal surface, and 20 cases at the central spinal cord. The sagittal diameter ranged from 1 to 58 mm (median: 17.3 mm). The transverse diameter ratio ranged from 20 to 80% (median: 50.7%). Thirty-two patients were diagnosed as deteriorative type and 22 were treated by ERS.ResultsAt 12 months after surgery, all patients were followed up, and no residual or recurrence was found in all patients. Twenty-five patients (48.1%) showed spinal cord functional improvement after surgery; 25 (48.1%) had no functional change; 2 (3.8%) got worse. For deteriorative patients, ERS group had a significantly higher improvement rate than the non-ERS group (χ2 = 5.393, P = 0.02); For all 52 patients, the factors as a lesion at the ventral surface (Z = 10.453, P = 0.015), or lumbosacral segment (χ2 = 9.259, P = 0.010) and longer course of disease (Z = −2.021, P = 0.043) were potential risks in functional recovery in univariate analysis; and in multiple-factor analysis, the lesion at the lumbosacral segment (OR = 4.004, 95% CI: 1.341~11.961, P = 0.013) was the independent risk factors for the functional recovery.ConclusionsMicrosurgical resection is safe and effective for symptomatic ISCH. The ERS is an effective way to improve deteriorative patients' spinal cord function at long-term follow-up. The lesion at the lumbosacral segment is one of the poor prognostic factors.

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Section: Discussionmentioning

confidence: 99%

The Long-Term Outcome in a Cohort of 52 Patients With Symptomatic Intramedullary Spinal Cavernous Hemangioma After Microsurgery and Emergency Rescue Surgery

et al. 2022

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Minimally invasive tubular approach to intramedullary cavernous malformations

Kantorowski,

Walker

2024

Surgical Neurology International

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Background: Advancements in minimally invasive spinal surgery have led to an expansion of targeted pathologies as well as improvements in surgical outcomes compared to their conventional counterparts through open laminectomy; however, this technique is rarely mentioned in the literature for intrinsic cord lesions. The authors present a novel minimally invasive, dorsolateral, and expandable tubular approach for the resection of an intradural, intramedullary thoracic cavernous malformation (CM). Case Descriptions: A 52-year-old male patient presented with rapidly progressive myelopathy and loss of ambulatory capabilities, with which magnetic resonance imaging revealed a hemorrhagic CM within the thoracic spinal cord. The CM was successfully resected through a minimally invasive tubular approach utilizing a dorsal root entry zone myelotomy. Postoperative imaging confirmed gross resection. His motor examination rapidly recovered, and he remains ambulatory with the use of a cane at a 2-year follow-up. Conclusion: This novel minimally invasive approach is a promising technique for well-selected cases of symptomatic spinal CMs. Further exploration and potentially randomized studies are necessary to fully affirm the tubular approach’s suitability for the treatment of intradural intramedullary CMs compared to conventional techniques.

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Lateral Myelotomy for Resection of a Ruptured Intramedullary Cervico-Thoracic Cavernous Malformation

Cited by 2 publications

References 8 publications

The Long-Term Outcome in a Cohort of 52 Patients With Symptomatic Intramedullary Spinal Cavernous Hemangioma After Microsurgery and Emergency Rescue Surgery

The Long-Term Outcome in a Cohort of 52 Patients With Symptomatic Intramedullary Spinal Cavernous Hemangioma After Microsurgery and Emergency Rescue Surgery

Minimally invasive tubular approach to intramedullary cavernous malformations

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