RADICAL EXCISION OF INTRAMEDULLARY CAVERNOUS ANGIOMAS

OBJECTIVE: This is a retrospective study of patients with surgically t reated, intramedullary cavernous malformations. We conducted the study to elucidate the outcomes of the patients, as well as potential pitfa lls in their care. METHODS: A series of 12 patients underwent radical excision of intramedullary cavernous malformations between 1986 and 19 96. All lesions were diagnosed by magnetic resonance imaging. Although seven patients experienced recurrent episodes of pain and sensorimoto r disturbances, the histories of the other five patients were relevant for slowly progressing deficits (mostly sensory). RESULTS: All cavern omas were completely resected. No deaths were recorded. In follow-up e xaminations (5-102 mo after discharge), there was no evidence of recur rence, either clinically or in control magnetic resonance imaging scan s. In follow-up examinations, two patients demonstrated sensory defici ts that were slightly more pronounced than the preoperative deficits. The postoperative neurological status of 3 of 12 patients was unchange d, compared with the preoperative status. The status of the remaining seven patients had improved. For four patients there was effective fun ctional improvement, and for three others there was complete postopera tive relief of pain. Deficits of the long tracts were less prone to re cover. CONCLUSION: The clinical course of cavernous malformations may be difficult to distinguish from that of spinal dural arteriovenous ma lformations or focal demyelinating disease. In the latter case, even m agnetic resonance imaging results could be deceptive. Radical resectio n of these malformations is feasible, with relatively low surgical mor bidity, provided that the preoperative deficits of the patients are li mited. Given the generally progressive course of the illness and the f ew acute catastrophic myelopathies, complete excision is advocated whe never malformations are symptomatic.