#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Long-term Postoperative Clinical Outcomes after Intramedullary Cavernoma Resection


Authors: N. Svoboda 1;  O. Bradáč 1;  V. Beneš 1
Authors place of work: Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN – VFN Praha 1
Published in the journal: Cesk Slov Neurol N 2017; 80/113(5): 564-568
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2017564

Summary

Introduction:
Cavernomas are rare vascular malformations originating from any part of the central nervous system (CNS). They are associated with severe morbidity. Resection of such a lesion is the only curative approach. Aim: To evaluate outcomes of patients undergoing resection of intramedullary cavernoma (IMC).

Methods:
We analysed retrospectively records of patients who underwent resection of pathologically confirmed IMC between 1998 and 2016. Preoperative status and magnetic resonance imaging were evaluated as well as immediate and long-term postoperative outcomes.

Results:
We performed 20 surgeries (12%) in 17 patients. Male to female ratio was 13 : 4. The mean patient age was 43 years at the time of surgery. Spinal levels of cavernomas were cervical in seven patients (35%) and thoracic in 13 patients (65%). The mean volume was 1.3 ml (0.2–6 ml). In six patients (35%), multiple cavernomas of the CNS were discovered and in one patient (6%), a hereditary CCM1 mutation was confirmed. Symptoms were motoric in 14 patients (70%), sensory in 13 patients (65%) and bladder and/or bowel in three patients (15%). Nine patients (45%) presented with an acute, three patients (15%) with a stepwise and eight patients (40%) with a progressive neurological decline. The calculated annual risk of haemorrhage was 2.3%. Long-term improvement was observed in seven patients (35%), 12 patients (60%) remained stable and one patient deteriorated.

Conclusion:
Based on our results, we conclude that it is convenient to perform IMC resection when it starts to be symptomatic. We should avoid waiting until the patient deteriorates.

Key words:
cavernoma – cavernous hemangioma – central nervous system – spinal cord vascular diseases

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Chinese summary - 摘要

髓内海绵状血管瘤切除手术后长期术后临床效果观察

介绍:

海绵状血管瘤是一种起源于中枢神经系统(CNS)任何部分的罕见型血管畸形。该疾病伴随着严重的并发症。切除这种病变是唯一的有效治疗方法。

目的:评估进行过髓内海绵状血管瘤切除术(IMC)患者的预后情况。

方法:

我们分析了1998至2016年期间接受病理证实的IMC切除术患者的回顾性记录。评估了患者的术前状态和磁共振成像结果,以及术后近期和远期的疗效情况。

结果:

我们对17名患者进行了20次手术(12%)。男女比例为13:4。手术时平均患者年龄为43岁。7名患者(35%)的海绵状血管瘤脊柱水平为宫颈,13名患者(65%)为胸椎。平均体积为1.3ml(0.2-6ml)。其中6例患者(35%)发现了CNS多发性海绵状血管瘤,1例患者(6%)确诊为遗传性CCM1突变。14例患者(70%)有肌肉运动症状,13例(65%)有感觉障碍,3例(15%)有膀胱和/或肠道感染。9例患者(45%)出现急性神经衰退,3例(15%)出现逐步神经衰退,8例(40%)出现进行性神经衰退。计算出的年出血风险为2.3%。7例患者(35%)出现长期改善,12例(60%)保持稳定,1例恶化。

结论:

根据结果,我们得出结论:当IMC开始出现症状时,进行IMC切除是很方便的。 我们应该避免等到病人病情恶化。

关键词:

血管瘤 - 海绵状血管瘤 - 中枢神经系统 - 脊髓血管疾病


Zdroje

1. Del Curl­­ing O Jr, Kel­ly DL Jr, Elster AD, et al. An analysis of the natural history of cavernous angiomas. J Neurosurg 1991;75(5):702– 8.

2. Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma. J Neurosurg 1991;75(5):709– 14.

3. Liang JT, Bao YH, Zhang HQ, et al. Management and prognosis of symp­tomatic patients with intramedul­lary spinal cord cavernoma: clinical article. J Neurosurg Spine 2011;15(4):447– 56.

4. Jel­linger K. Pathology of Spinal Vascular Malformations and Vascular Tumors. In: Pia HW, Djindjian R, eds. Spinal Angiomas: Advances in Dia­gnosis and Therapy. Berlin: Springer Berlin Heidelberg 1978:18– 44.

5. Ogilvy CS, Louis DN, Ojemann RG. Intramedul­lary cav­ernous angiomas of the spinal cord: clinical presentation, pathological features, and surgical management. Neurosurgery 1992;31(2):219– 29; discus­sion 229– 30.

6. Bian LG, Bertalanf­fy H, Sun QF, Shen JK. Intramedul­lary cavernous malformations: clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 2009;111(6):511– 7. doi: 10.1016/ j.clineuro.2009.02.003.

7. Badhiwala JH, Far­rokhyar F, Alhazzani W, et al. Surgical outcomes and natural history of intramedul­lary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data: Clinic article. J Neurosurg Spine 2014;21(4):662– 76. doi: 10.3171/ 2014.6.SPINE13949.

8. Májovský M, Netuka D, Bradáč O, et al. Chirurgická léčba supratentoriálních kortiko-subkortikálních kavernomů. Cesk Slov Neurol N 2014;110(5):631– 37.

9. Bradac O, Majovsky M, de Lacy P, et al. Surgery of brainstem cavernous malformations. Acta Neurochir (Wien) 2013;155(11): 2079– 83. doi: 10.1007/ s00701-013-1842-6.

10. Gross BA, Du R, Popp AJ, et al. Intramedul­lary spinal cord cavernous malformations. Neurosurg Focus 2010;29(3):E14. doi: 10.3171/ 2010.6.FOCUS10144.

11. Mitha AP, Turner JD, Abla AA, et al. Outcomes fol­low­­ing resection of intramedul­lary spinal cord cavernous malformations: a 25-year experience. J Neurosurg Spine 2011;14(5):605– 11.

12. Labauge P, Bouly S, Parker F, et al. Outcome in 53 patients with spinal cord cavernomas. Surg Neurol 2008;70(2):176– 81; discus­sion 181. doi: 10.1016/ j.surneu. 2007.06.039.

13. McCormick PC, Tor­res R, Post KD, et al. Intramedul­lary ependymoma of the spinal cord. J Neurosurg 1990;72(4):523– 32.

14. Canavero S, Pagni CA, Duca S, et al. Spinal intramedul­lary cavernous angiomas: a literature meta-analysis. Surg Neurol 1994;41(5):381– 8.

15. Zevgaridis D, Medele RJ, Hamburger C, et al. Cav­ernous haemangiomas of the spinal cord. A review of 117 cases. Acta Neurochir (Wien) 1999;141(3):237– 45.

16. Aoyama T, Hida K, Houkin K. Intramedul­lary cav­ern­ous angiomas of the spinal cord: clinical characteristics of 13 lesions. Neurol Med Chir (Tokyo) 2011;51(8):561– 6.

17. Endo T, Aizawa-Kohama M, Nagamatsu K, et al. Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intramedul­lary cavernous malformations: report of 8 cases. J Neurosurg Spine 2013;18(5):443– 9. doi: 10.3171/ 2013.1.SPINE12482.

18. Jal­lo GI, Freed D, Zareck M, et al. Clinical presentation and optimal management for intramedul­lary cavernous malformations. Neurosurg Focus 2006;21(1):e10.

19. Kharkar S, Shuck J, Conway J, et al. The natural history of conservatively managed symp­tomatic intramedul­lary spinal cord cavernomas. Neurosurgery 2007;60(5):865– 72; discus­sion 865– 72.

20. Lu DC, Lawton MT. Clinical presentation and surgical management of intramedul­lary spinal cord cavern­ous malformations. Neurosurg Focus 2010;29(3):E12. doi: 10.3171/ 2010.6.FOCUS10139.

21. Tong X, Deng X, Li H, et al. Clinical presentation and surgical outcome of intramedul­lary spinal cord cav­ernous malformations. J Neurosurg Spine 2012;16(3):308– 14. doi: 10.3171/ 2011.11.SPINE11536.

22. Odom GL, Woodhall B, Margolis G. Spontaneous hematomyelia and angiomas of the spinal cord. J Neurosurg 1957;14(2):192– 202.

23. Marusič P. Dia­gnostika epileptických záchvatů. Cesk Slov Neurol N 2015;78(111):253–62.

24. Cantore G, Delfini R, Cervoni L, et al. Intramedul­lary cavernous angiomas of the spinal cord: report of six cases. Surg Neurol 1995;43(5):448– 51; discus­sion 451– 2.

25. Kim LJ, Klopfenstein JD, Zabramski JM, et al. Analysis of pain resolution after surgical resection of intramedul­lary spinal cord cavernous malformations. Neurosurgery 2006;58(1):106– 11; discus­sion 106– 11.

26. Deutsch H. Pain outcomes after surgery in patients with intramedul­lary spinal cord cavernous malformations. Neurosurg Focus 2010;29(3):E15. doi: 10.3171/2010.6.FOCUS10108.

27. Andrašinová T. Spinální arteriovenózní malformace –  dvě kazuistiky. Cesk Slov Neurol N 2014;77(110):505– 509.

28. Smrčka M. Problematika indikace operační léčby u intramedulárních lézí. Cesk Slov Neurol N 2010;73(106):393– 397.

29. Brotchi J. Intrinsic spinal cord tumor resection. Neurosurgery 2002;50(5):1059–63.

Štítky
Paediatric neurology Neurosurgery Neurology

Článok vyšiel v časopise

Czech and Slovak Neurology and Neurosurgery

Číslo 5

2017 Číslo 5
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#