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
