Functional neurological outcome of spinal cavernous malformation surgery

Laurèl Rauschenbach, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany. laurel.rauschenbach@uk-essen.de.
Alejandro N. Santos, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Adrian Engel, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Angelina Olbrich, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Arnau Benet, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.Follow
Yen Li, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Börge Schmidt, Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.
Oliver Gembruch, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Neriman Özkan, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Ramazan Jabbarli, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Karsten H. Wrede, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Adrian Siegel, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.Follow
Ulrich Sure, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Philipp Dammann, Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.

Document Type

Article

Abstract

PURPOSE: Spinal cavernous malformations (SCM) present a risk for intramedullary hemorrhage (IMH), which can cause severe neurologic deficits. Patient selection and time of surgery have not been clearly defined. METHODS: This observational study included SCM patients who underwent surgery in our department between 2003 and 2021. Inclusion required baseline clinical factors, magnetic resonance imaging studies, and follow-up examination. Functional outcome was assessed using the Modified McCormick scale score. RESULTS: Thirty-five patients met the inclusion criteria. The mean age was 44.7 ± 14.5 years, and 60% of the patients were male. In univariate analysis, the unfavorable outcome was significantly associated with multiple bleeding events (p = .031), ventral location of the SCM (p = .046), and incomplete resection (p = .028). The time between IMH and surgery correlated with postoperative outcomes (p = .004), and early surgery within 3 months from IMH was associated with favorable outcomes (p = .033). This association remained significant in multivariate logistic regression analysis (p = .041). CONCLUSIONS: Removal of symptomatic SCM should be performed within 3 months after IMH when gross total resection is feasible. Patients with ventrally located lesions might be at increased risk for postoperative deficits.

Medical Subject Headings

Humans; Male; Adult; Middle Aged; Female; Treatment Outcome; Retrospective Studies; Neurosurgical Procedures (adverse effects, methods); Musculoskeletal Abnormalities; Magnetic Resonance Imaging; Spinal Cord Neoplasms (surgery)

Publication Date

5-1-2023

Publication Title

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

E-ISSN

1432-0932

Volume

32

Issue

5

First Page

1714

Last Page

1720

PubMed ID

36928489

Digital Object Identifier (DOI)

10.1007/s00586-023-07640-5

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