A systematic review on the outcome of intramedullary spinal cord cavernous malformations

• Published in: European spine journal 2022-11, Vol.31 (11), p.3119-3129
• Main Authors: Asimakidou, Evridiki, Meszaros, Lieropi Tzanetaki, Anestis, Dimitrios M., Tsitsopoulos, Parmenion P.
• Format: Article
• Language: English
• Subjects: Complications; Lesions; Medicine; Medicine & Public Health; Neurosurgery; Patients; Review Article; Spinal cord; Spine (thoracic); Surgery; Surgical Orthopedics; Systematic review
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-022-07332-6

Purpose This study aimed to investigate the neurological outcome, trends and sequelae following surgical or conservative treatment of intramedullary spinal cord cavernous malformations (ISCCMs). Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measure was the change in the neurological status after surgery or conservative management. A logistic regression analysis investigating prognostic factors related to outcome was also performed. Results Twenty-one studies with 1091 patients in total were included, of which 1005 (92.1%) underwent surgical resection and 86 (7.9%) were treated conservatively. Gross total resection was achieved in 95.7% of the patients and partial resection in 4.3%. Most lesions (60.2%) were located in the thoracic spine and presented with motor (60.4%) and sensory deficits (59.7%). In the long term, surgical treatment resulted in an improved neurological status in 36.9% of the patients, in 55.8% it remained stable, and in 7.3% it deteriorated compared to the preoperative state. In the conservative cohort, 21.7% improved, 69.6% remained stable, and 8.7% deteriorated. Solitary lesions, duration of preoperative symptoms less than 3 months as well as an improved post-operative neurological status were predictors of a favourable long-term outcome. Conclusions Whenever feasible, symptomatic patients with ISCCM are recommended to undergo surgery within 3 months from symptom onset. Absence of multiple lesions and, most importantly, post-operative symptom improvement foresee a favourable long-term outcome. Further research is warranted to discern the role of conservative treatment in symptomatic patients.