Cavernous haemangiomas of the spinal cord. A review of 117 cases

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, prog nostic factors and therapeutic strategies considering both our own experien ce and reports from the literature. The data of 48 studies (published between 1903 and 1996), presenting inform ation of all together 107 patients (108 lesions) regarding pre-treatment cl inical and radiological factors, treatment strategies, and the outcome, plu s our own experience of nine patients were retrospectively re-analyzed. The prognostic influence of pre-treatment factors was estimated with the chi-s quare statistics. Clinical evaluation before/after treatment was performed using the Frankel scale. The average bleeding rate was obtained from the ra tio of percentage of first bleeding events in the population to the mean ag e of the population. There were 47 males and 69 females (aged from twelve to 88 years). Thirty n ine 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 presentat ion was in the fourth decade, the median duration of symptoms was 32 months . Clinical symptoms before treatment were progressive in all cases. Three p atterns of clinical presentation could be identified: a) episodes of stepwi se clinical deterioration (30%), b) slow progression of neurological declin e (41%), c) acute onset with rapid or gradual decline over weeks or months (26%). 58% of the lesions showed clinical or radiological signs of haemorrh age. In 66% of surgical patients (91 efficiently documented cases), clinica l improvement was achieved, 28% remained unchanged and 6% deteriorated. Whe reas 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 s igns caused by the malformation have appeared, the patients tend to experie nce progressive neurological deterioration.