Intramedullary cavernous angioma - Resection by oblique corpectomy

BACKGROUND Intramedullary cavernomas are rare lesions usually operated on via a poster ior approach and myelotomy. CASE REPORT A 42-year-old woman progressively developed a tetraplegia with sphincter di sturbances over a period of 26 years. Magnetic resonance imaging showed a c ervical intramedullary cavernoma with an extramedullary anterolateral exoph ytic portion. To avoid myelotomy, this lesion was approached directly via i ts anterior exophytic portion. Through a cervical anterolateral approach, t he vertebral body of C4 and the intervertebral discs were obliquely drilled out. The posterior longitudinal ligament and the dura mater were opened. T he exophytic portion was coagulated and the intramedullary portion was comp letely excised. The dura mater was closed and a bone graft was inserted bet ween C3 and C5 and secured with a plate. RESULTS After transient worsening, upper limb weakness improved from its preoperati ve status but paraparesis persisted after a follow-up of 12 months. The sph incter disturbances disappeared. CONCLUSIONS The anterolateral approach combined with oblique corpectomy may be an appro priate technique in case of anterior intramedullary cavernomas. It provides direct access to the lesion, avoiding additional myelotomy. (C) 1999 by El sevier Science Inc.