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J Neurol Surg A Cent Eur Neurosurg 2012; 73(03): 125-131
DOI: 10.1055/s-0032-1304811
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Spinal Cord Cavernoma—Operative Strategy and Results in 30 Patients

Dorothee Wachter
1   Neurochirurgie, Georg-August-Universität Göttingen, Göttingen, Germany
,
Marios Psychogios
2   Neuroradiology, Georg-August-University Göttingen, Göttingen, Germany
,
Joachim Michael Gilsbach
3   Neurochirurgie, RWTH Aachen, Aachen, Germany
,
Veit Rohde
1   Neurochirurgie, Georg-August-Universität Göttingen, Göttingen, Germany
› Institutsangaben
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Publikationsverlauf

31. Juli 2011

12. Oktober 2011

Publikationsdatum:
30. April 2012 (online)

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Abstract

Background Many case reports and small series addressing the surgical management of spinal cord cavernoma have been published. However, only few larger series that would allow identifying operative strategies exist. After having treated 30 patients, we feel encouraged to report our experiences.

Methods A total of 30 patients (13 men and 17 women) were mainly admitted to our institution because of sensory deficits (83.3%), paresis (33.3%), and bladder dysfunction (26.6%). Magnetic resonance imaging revealed a spinal cavernoma mostly in the thoracic region (63.3%). All patients underwent surgery. The relation between pial surface and cavernoma guided the choice of approach and the myelotomy site.

Results After laminectomy/laminoplasty, median myelotomy was done in 16.7% to reach a medially located cavernoma. In 60.0%, myelotomy was located at the dorsal root entry zone, for which a (partial) hemilaminectomy was sufficient. The laterality of the location guided the bony approach in the remaining 23.3% with exophytic cavernoma. Immediately after surgery, neurological worsening was seen in 56.7%, an improvement in 10.0% and an unchanged neurological status in 33.3%. During the follow-up, the rate of neurological worsening dropped to 10.0%, the improvement rate increased to 50.0%. In 40.0% of the patients, the symptoms remained unchanged or returned to preoperative status.

Conclusion The exact localization in relation to the pial surface guides the approach and area of myelotomy. In the majority of patients limited approaches are sufficient for successful cavernoma removal. In our series anterior approaches had not been necessary.

Keywords

spinal cord cavernoma - surgical techniques - approach
 

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