67 Spinal Cord Cavernous Malformations

Intramedullary cavernous malformations (CVMs) of the spinal cord were diagnosed in 2 adult dogs that presented for paraparesis. An intramedullary spinal cord lesion was identified on a myelogram in the first dog, and expansion of the vertebral canal was evident on radiographs in the second. Extensive intraparenchymal hemorrhage was found on gross postmortem examination in both dogs, and a distinct lobulated intramedullary mass was evident in the second dog. Microscopically, both lesions were composed of dilated, thin-walled vascular channels with little-to-no intervening neural parenchyma. Both dogs had evidence of channel thrombosis along with perilesional hemorrhage and hemosiderin accumulation. The second dog had additional degenerative changes, including thickened fibrous channel walls with hyalinization, foci of mineralization, and occasional tongues of entrapped gliotic neuropil. CVMs appear to be an uncommon cause of both acute and chronic spinal cord disease in the dog.

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Patients with Spinal Cord Cavernous Malformations Are at an Increased Risk for Multiple Neuraxis Cavernous Malformations

Neurosurgery ◽

10.1227/00006123-199907000-00008 ◽

1999 ◽

Vol 45 (1) ◽

pp. 30 ◽

Cited By ~ 1

Author(s):

A. Giancarlo Vishteh ◽

Joseph M. Zabramski ◽

Robert F. Spetzler

Keyword(s):

Spinal Cord ◽

Cavernous Malformations ◽

Increased Risk

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Intramedullary spinal cord cavernous malformations: clinical features and risk of hemorrhage

Neurosurgical Review ◽

10.1007/s10143-003-0260-2 ◽

2003 ◽

Vol 26 (4) ◽

pp. 253-256 ◽

Cited By ~ 76

Author(s):

Ibrahim Erol Sandalcioglu ◽

Helmut Wiedemayer ◽

Thomas Gasser ◽

Siamek Asgari ◽

Tobias Engelhorn ◽

...

Keyword(s):

Spinal Cord ◽

Clinical Features ◽

Intramedullary Spinal Cord ◽

Cavernous Malformations ◽

Risk Of Hemorrhage

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Modified classification of spinal cord vascular lesions

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.2.0145 ◽

2002 ◽

Vol 96 (2) ◽

pp. 145-156 ◽

Cited By ~ 133

Author(s):

Robert F. Spetzler ◽

Paul W. Detwiler ◽

Howard A. Riina ◽

Randall W. Porter

Keyword(s):

Spinal Cord ◽

Classification System ◽

Arteriovenous Malformations ◽

Vascular Malformations ◽

Relevant Literature ◽

Vascular Lesions ◽

Cavernous Malformations ◽

Content Type ◽

Arteriovenous Fistulas ◽

Fine Print

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

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Spinal intramedullary cavernomas. Personal experience reffering to six cases

Romanian Neurosurgery ◽

10.2478/romneu-2014-0056 ◽

2014 ◽

Vol 21 (4) ◽

pp. 407-415 ◽

Cited By ~ 1

Author(s):

G. Iacob ◽

Angela Olarescu

Keyword(s):

Spinal Cord ◽

Dorsal Surface ◽

Neurological Status ◽

Duration Of Symptoms ◽

Cavernous Malformations ◽

Excellent Outcome ◽

Presenting Symptoms ◽

Asymptomatic Patients ◽

Microsurgical Techniques

Abstract Despite cavernous malformations of the CNS are pathologically similar, intramedullary cavernous malformations are very rare lesions, increasingly recognized after introduction of magnetic resonance image, generating gradual neurological decline, with severe deficits or acute loss of spinal function. We report our experience on six patients with intramedullary cavernomas defining the spectrum of presenting symptoms and signs analyzing the role of surgery as a treatment for these lesions. We present our experience with 2 cervical and 4 thoracal spinal intramedullary cavernoma from 2010 to 2014 searching history, onset of clinical manifestation, neurological status, radiological findings, operation, and clinical outcome. Among 6 patients male were 2 cases; female 4 cases; mean age was 42 years (range 25-72 years); mean duration of symptoms were 1,5 years (range 5 days and 2 years) with slowly progressive neurological decline. In two cases there was acute onset of neurological compromise. In all cases diagnosis was made on MRI and lesions were possible to be radically excised and gently extracted from the hemosiderin-stained bed inside of the spinal cord via a laminectomy and midline myelotomy with microsurgical techniques. The surgical outcome on a mean duration of follow up of 12 months were: for 4 cases - the patients neurological conditions remarkably improved 1 month later, for 2 cases no improvement were remarked. No recurrent hemorrhages were recorded. A follow-up MRI examination was made in all cases to confirm complete removal of the cavernous angioma. Spinal intramedullary cavernoma should be early recognized by MRI, can be positioned in a precarious position and generate significant neurologic deficits than cranial cavernomas. For symptomatic intramedullary cavernous malformations extended to the dorsal surface of the spinal cord, total resection with microsurgical techniques can offer good or excellent outcome, restoring neurological status and to stop chronic deterioration and acute rebleeding. To asymptomatic patients with deeper lesions which entail a higher operative risk, but also a surgically manageable cause of myelopathy a closed observation is mandatory.

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Influence of Pregnancy on Hemorrhage Risk in Women With Cerebral and Spinal Cavernous Malformations

Stroke ◽

10.1161/strokeaha.120.031761 ◽

2021 ◽

Vol 52 (2) ◽

pp. 434-441

Author(s):

Nycole K. Joseph ◽

Shivram Kumar ◽

Robert D. Brown ◽

Giuseppe Lanzino ◽

Kelly D. Flemming

Keyword(s):

Spinal Cord ◽

Neurological Complications ◽

Reproductive Age ◽

Childbearing Age ◽

Cavernous Malformations ◽

Familial Form ◽

Hemorrhage Risk ◽

Risk Of Hemorrhage ◽

Record Review

Background and Purpose: Pregnancy as a hemorrhage risk factor in women with cavernous malformations (CMs) is controversial. We describe prospective hemorrhage risk in women who become pregnant after an established CM diagnosis. Methods: Beginning in 2015, we recruited consecutive patients with radiologically confirmed CM of the brain or spinal cord to participate in a prospective registry. Participants underwent a baseline and annual medical record review, imaging review, and annual surveys to ascertain pregnancies, deliveries, and neurological complications. We collected prospective hemorrhage data on reproductive age women. We calculated prospective hemorrhage rates on childbearing age patients based on the number of hemorrhages occurring post-CM diagnosis during pregnancy and nonpregnancy, divided by the years of follow-up and censored at last follow-up, age 46, or surgery in sporadic-form CM. The hemorrhage rates were compared and the 95% CI presented with a P value of <0.05. Results: Of 160 women, 90 presented with CM under the age of 46 (average age 31.6 years; 25.6% familial form; 46.7% with hemorrhage; 24.4% brain stem location). These 90 patients had 136 pregnancies before CM diagnosis; 36 pregnancies occurred at or after the diagnosis of CM. Four patients had a hemorrhage while pregnant or postpartum leading to the first CM diagnosis. During 402.6 years of follow-up while not pregnant, 42 hemorrhages occurred prospectively yielding a 10.4% per year (95% CI, 7.5–14.0) risk of hemorrhage while not pregnant. No hemorrhages occurred during 32 prospective pregnancies (26 live births including 1 twinset and 7 nonviable fetuses) after CM diagnosis during 26.9 years of pregnancy time yielding a rate of 0% per year (95% CI, 0–13.6). We found no statistical difference in the rates of hemorrhage during pregnant and nonpregnant time ( P =0.09). No hemorrhage occurred during delivery. Conclusions: Our prospective data suggest that pregnancy does not increase the risk of hemorrhage in women with a known brain or spinal cord CM and that vaginal delivery is safe in appropriate candidates.

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