An analysis of the natural history of cavernous angiomas.

The advent of magnetic resonance (MR) imaging has permitted the recognition of many angiographically occult vascular malformations before the development of complications and subsequent surgical removal. This study reviews all patients at one institution who had radiographically identifiable vascular malformations believed to represent cavernous angiomas in order to obtain information on the natural history of this particular lesion. All 8131 craniospinal MR images performed at our medical center from January 1, 1986, to November 30, 1989, were reviewed, and 32 patients were identified with 76 lesions meeting the MR imaging criteria for cavernous angioma. Medical histories, physical examination records, and other data from these patients were then reviewed to determine the frequency of complications. Their mean age at latest follow-up examination (or at surgical removal of the lesion) was 37.6 years (range 16 to 72 years). Sixteen patients (50%) had a history of seizures, seven (22%) had focal neurological deficits, and three (9%) had clinically significant hemorrhage attributable to the cavernous angioma; six patients (19%) were asymptomatic. The estimated risk of hemorrhage for this population is 0.25%/person-year of exposure; the estimated risk of seizure development is 1.51%/person-year. Eight patients underwent surgical procedures, resulting in improved seizure control and/or lessened neurological deficit. Although these lesions are often excised with relative ease and minimal morbidity, the potential risks and benefits of surgery must be weighed carefully before removal of these relatively benign malformations.

The natural history of intracranial venous angiomas.

Cerebral venous angiomas are congenital anomalies of the intracranial venous drainage. Many believe that they are associated with a high risk of hemorrhage and neurological dysfunction, but newer neurodiagnostic imaging techniques are showing not only that they are more common than previously known but also that many have no associated symptoms. In this retrospective study, the natural history of venous angiomas was examined in 100 patients (48 males and 52 females) with radiographically identifiable lesions treated over a 14-year period. Information on the natural history of the lesion was obtained from clinical records and follow-up data. Imaging studies included angiography, computerized tomography, and magnetic resonance imaging. Angioma locations were classified as frontal (42 cases), parietal (24 cases), occipital (4 cases), temporal (2 cases), basal or ventricular (11 cases), cerebellar (14 cases), or brain stem (3 cases); 47 lesions were on the left side. Headache as a presenting symptom was common (36 patients) and often led to other radiographic studies, but this appeared to be related to the vascular lesion in only four patients. Other possibly related complications were hemorrhage in one patient, seizures in five, and transient focal deficits in eight. Fifteen patients had no neurological signs or symptoms. The mean patient age at last contact was 45.3 years (range 3 to 94 years). All patients have been managed without surgery. It is concluded that significant complications secondary to venous angiomas are infrequent and that surgical resection of these lesions and of surrounding brain is rarely indicated.

Changing concepts in spinal epidural abscess: a report of 29 cases.

A review of our recent experience with spinal epidural abscess (SEA) reveals several important changing concepts in diagnosis, etiology, management, and outcome. All cases of SEA seen by our service from August 1975 to July 1989 were reviewed retrospectively, and 29 patients were identified (19 men and 10 women, aged 13-78 years). Abscesses were located in the lumbar (n = 21), thoracic (n = 7), and cervical (n = 1) epidural spaces. Gram-positive organisms were the infectious agent in 72% of the cases, and Staphylococcus aureus was the sole agent in 45%; other agents were Gram-negative aerobes (n = 5), a Gram-negative anaerobe (n = 1), Mycobacterium tuberculosis (n = 1), and Sporotrichum schenckii (n = 1), the last occurring in a young woman with acquired immune deficiency syndrome. Seventeen patients had concomitant extraspinal infections. Diagnosis was confirmed by myelography, computed tomography, or magnetic resonance imaging. All patients underwent operative decompression and debridement; 2 required a second procedure for persistent infection. The most common operative findings were pus and granulation tissue in the epidural space (52%); the preoperative course correlated poorly with operative findings. The wound was closed primarily in 84% of cases. Postoperative intravenous antibiotic courses for the bacterial abscesses ranged from 1.5 to 6 weeks (median, 2 weeks), followed by antibiotics given orally for 0 to 6 weeks. Two patients died perioperatively. Neurological outcome was good in 21 patients and fair in 6 (mean follow-up, 1.4 years). Over the last 50 years the spectrum of organisms causing SEA has broadened, and the distinction between acute and chronic SEAs has minimal clinical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Diastematomyelia--a 40-year experience.

Diastematomyelia is a rare but potentially devastating spinal dysraphism classically characterized as a bony or fibrous spur separating two hemispinal cords. This study reviews our experience with diastematomyelia over a 40-year period from 1947 through 1987, and suggests that the neurologic and orthopedic deficits of diastematomyelia remain stable during extended follow-up after surgery.