Intramedullary Spinal Cord Cavernous Malformation

Indications

• Some experts advocate surgical resection for intramedullary spinal cord cavernous malformation only after progressive neurologic deterioration or for pain, which is often the presentation seen in adults. Others recommend surgical treatment after hemorrhage within the spinal cord, which is more commonly seen in children.

• Some neurosurgeons support early surgical intervention in symptomatic patients to halt neurologic decline. Resection of a lesion within 2 to 3 months of the occurrence of symptoms may correlate positively with a favorable neurologic outcome.

• We recommend definitive surgical resection in all symptomatic patients, because untreated lesions may result in progressive neurologic decline. In addition, resection prevents potential hemorrhage, which carries with it a significant risk of neurologic compromise. The annual bleeding risk for untreated spinal cavernous malformations varies in different publications and was previously described as up to 7%. However, most of the publications cite a 2% to 3% annual bleeding risk.

• Patients with transient minor symptoms or asymptomatic lesions may be suitable for observation only without operative treatment. Yet in cases in which the lesion protrudes through the surface of the pia (especially dorsal pia) and the patient presents with transient symptoms, the lesion may be considered for resection taking into account surgical risks in a case-specific basis. In any case (e.g., asymptomatic lesion) that the surgeon decides on observation only, our recommendation is for close clinical and radiologic follow-up.