Surgical Treatment of Spinal Cord Intramedullary Cavernous Angioma

ABSTRACT

Cavernous angiomas are commonly found within the intracranial cavity. However, these malformations are uncommon in the spinal column and rarely found within the spinal cord. There have been only a few isolated reports on surgical resection for spinal cord intramedullary cavernous malformations. However, cavernous angiomas are being increasingly well recognized throughout the central nervous system since introduction of magnetic resonance image(MRI). A series of six patients with spinal cord intramedullary cavernous angioma, which were treated by complete surgical excision, is described. Intramedullary cavernous angiomas cause sensorimotor symptoms, typically with progressive painful paraparesis. The cavernous angioma manifest as reticulated mixed signal areas on both T-1 and T-2 weighted images, surrounded by low signal intensity prominent in T-2 weighted images. Intramedullary cavernous angiomas are mostly located in dorsal aspect of spinal cord. In the five cases, a bluish area is visible on the spinal surface and myelotomy is performed at this level. Four cases improved but two cases worsened in Nurick classification. A worsened case had a ventrally located cavernous angioma. Sensory function were aggravated in four cases. It is concluded that intramedullary spinal cord cavernous angiomas are uncommon causes of progressive myelopathy that can be safely and effectively treated by surgical excision.