Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience

2011 ◽  
Vol 14 (5) ◽  
pp. 605-611 ◽  
Author(s):  
Alim P. Mitha ◽  
Jay D. Turner ◽  
Adib A. Abla ◽  
A. Giancarlo Vishteh ◽  
Robert F. Spetzler
Keyword(s):  
Spinal Cord ◽  
Clinical Status ◽  
Term Outcome ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Single Center Experience ◽  
Csf Leakage ◽  
Preoperative Status

Object The management of intramedullary spinal cord cavernous malformations (CMs) is controversial. At Barrow Neurological Institute, the authors selectively offer surgical treatment for symptomatic spinal cord CMs. The purpose of this paper is to review the clinical outcomes in patients after resection of these lesions based on a single-center experience over a 25-year period. Methods The records of 80 patients who underwent resection of pathologically confirmed spinal cord CMs from January 1985 to May 2010 were analyzed retrospectively. Preoperative clinical status and imaging findings were evaluated as well as immediate and long-term postoperative outcomes. Results Compared with their preoperative Frankel grade, 11% of patients were worse, 83% were the same, and 6% improved immediately after surgery. At a mean follow-up interval of 5 years, 10% of patients were worse, 68% were the same, and 23% were improved compared with their preoperative status. Five percent of patients underwent reoperation for resection of a symptomatic residual or recurrent lesion. Immediate complications were encountered in 6% of patients, including CSF leakage and deep venous thrombosis. Long-term complications were encountered in 14% of patients and included kyphotic deformity, stenosis, and spinal cord tethering. A significant correlation was found between long-term outcome and anteroposterior length of the lesion (p = 0.01). Conclusions The resection of intramedullary spinal cord CMs can be achieved with good long-term outcomes and an acceptable risk of immediate or delayed complications.

Outcome after Operative Treatment of Intramedullary Spinal Cord Tumors in Adults: Intermediate and Long-Term Results in 51 Patients

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 855-859 ◽  
Author(s):  
Paul R. Cooper
Keyword(s):  
Spinal Cord ◽  
Operative Treatment ◽  
Extent Of Resection ◽  
Long Term Results ◽  
Spinal Cord Tumors ◽  
Term Outcome ◽  
Intramedullary Spinal Cord ◽  
Long Term Outcome ◽  
Results Of Treatment

Abstract The reported results of treatment of intramedullary spinal cord tumors (IMSCT) are difficult to interpret because of heterogeneous management strategies, small numbers of patients, and short periods of follow-up. In 1985 we published the early results of operative treatment of 29 patients with IMSCT and were cautiously optimistic that aggressive operative management would have a salutary effect on long-term outcome. In this report, the most recent clinical status of these 29 original patients is reviewed, along with that of 22 additional ones, to assess the intermediate and long-term results of treatment of IMSCT in 51 patients who underwent microsurgical resection between 1981 and 1987. Of these 51 patients, 24 had ependymomas, 18 had astrocytomas, and the remainder had a variety of less common lesions. Thirty-seven patients survive and have been followed for periods up to 72 months (mean 38 months). The neurological conditions of 21 patients are improved or have stabilized following operation. The conditions of 16 patients are worse postoperatively: 11 from operation and 5 from progression of disease. Eight patients are neurologically intact, 7 walk independently but abnormally, 9 ambulate with the aid of a cane or walker, and the remaining 13 are not ambulatory. Twelve of 18 patients with astrocytomas and 2 of 24 patients with ependymomas have died after a mean survival of 10 months from operation. Patients with ependymomas who had gross total resection have fared the best, with no deaths or recurrences, but no relationship could be discerned between the extent of resection and outcome in patients with astrocytomas. The author concludes that radical resection of IMSCT may be performed with initial stabilization or improvement of neurological function in the majority of patients. In patients with ependymomas the extent of resection correlated well with long-term outcome. In patients with astrocytomas. however, there was no such relationship. All 7 patients with astrocytomas of Grades III and IV have died, as have 4 of 11 patients with astrocytomas of Grades I and II.

Characteristics and Long-Term Outcome of 20 Children With Intramedullary Spinal Cord Cavernous Malformations

Neurosurgery ◽  
2019 ◽  
Author(s):  
Jian Ren ◽  
Tao Hong ◽  
Gao Zeng ◽  
Chuan He ◽  
Xiaoyu Li ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pediatric Patients ◽  
Adult Patients ◽  
Consecutive Series ◽  
Long Term Outcomes ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Disability Status

Abstract BACKGROUND No prior reports have focused on the natural history and long-term outcomes of intramedullary spinal cord cavernous malformations (ISCCMs) in children. OBJECTIVE To investigate the clinical characteristics and long-term outcomes of pediatric ISCCMs and identify the risk of hemorrhage. METHODS We retrospectively reviewed a series of 20 pediatric patients (<18 yr old) from a consecutive series of 254 patients with ISCCMs evaluated at a single institution. RESULTS Of the 20 pediatric patients, 9 (45.0%) presented with a severe neurological and disability status. The annual hemorrhagic rate in pediatric patients was 8.2%/patient/year. After initial overt hemorrhage events, the annual overt rehemorrhage rate increased to 30.7%/patient/year. In 234 adult patients, the respective rates were 2.8% and 7.4%. Thoracic or lumbar level lesions (P = .002, OR = 3.425, 95% CI = 1.588-7.387) and rehemorrhagic events (P = .005, OR = 3.209, 95% CI = 1.415-7.279) were more likely to follow an aggressive course. There were no significant differences in the sex distribution, location and size of lesions, types of symptoms, likelihood of a severe neurological and disability status, or immediate and long-term postoperative outcomes between pediatric and adult patients with ISCCMs CONCLUSION The annual overt hemorrhage rate and rehemorrhage rate of ISCCMs were higher in affected children than in affected adults. Surgical resection of pediatric ISCCMs remains the preferred therapeutic option and provides favorable outcomes.

scholarly journals Surgical treatment and outcome of cerebral cavernomas – a 10 years’ experience

2014 ◽  
Vol 21 (4) ◽  
pp. 395-405
Author(s):  
A. Giovani ◽  
Aurelia Sandu ◽  
Angela Neacsu ◽  
R.M. Gorgan
Keyword(s):  
Vascular Malformations ◽  
Clinical Status ◽  
Low Flow ◽  
Vascular Lesions ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Long Term Follow Up

Abstract Cavernous malformations (cavernomas) are congenital low flow angiographic occult vascular lesions with a high tencency to bleeding. The prevalence of cerebral cavernous vascular malformations is estimated to be 0.4% to 0.9%.2,7 CMs in deep locations, including the brainstem, thalamus, and basal ganglia, account for 9% to 35% of all malformations in the brain. We performed a retrospective 10 years study on 130 operated cerebral cavernomas and discussed the clinical status at presentation, the choice and timing of the surgical approach and the short and longterm follow up. The 130 operated cases were divided into a supratentorial 102 (78.46%) group and an infratantorial group 28 (21.53%). The average age at presentation was 43,62 years old (17-76) and there was no sex predominance, male/female = 1,44 (77/53). Only in 14 cases (10.76%) we could find multiple cavernomas which had relatives with multiple cavrnomas, but the familial inheritance was not studied, and only the symptomatic lesion was resected. We divided the outcome results reporting for agroup with superficial respectively profound lesions. The long term follow up for the patients in the profound lesions group showed that 31/37 (83,78%) of patients had a mRS between 0 and 2, and the rest had a poor long term outcome. After surgery there was no clinical deterioration in the superficial lesions group and 22 patients from those who presented in mRS 2 showed neurological improvement on long term follow up, meaning that 82,79% of patients had a 0 or 1 mRS. Microsurgery is the treatment of choice in symptomatic brain cavernomas, total resection being the only curative treatment, capable to prevent further bleeding and to offer an efficient control of seizures.

scholarly journals Long Term Outcome of Non-Dysraphic Intramedullary Spinal Cord Lipomas in Adults: Case Series and Review

2014 ◽  
Vol 8 (4) ◽  
pp. 476 ◽  
Author(s):  
Uddanapalli Sreeramulu Srinivasan ◽  
Natarajan Raghunathan ◽  
Lawrence Radhi
Keyword(s):  
Spinal Cord ◽  
Case Series ◽  
Term Outcome ◽  
Intramedullary Spinal Cord ◽  
Long Term Outcome

scholarly journals Long term outcome of functional independence and quality of life after traumatic SCI in Germany

Spinal Cord ◽  
2021 ◽  
Author(s):  
Florian Möller ◽  
Rüdiger Rupp ◽  
Norbert Weidner ◽  
Christoph Gutenbrunner ◽  
Yorck B. Kalke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Functional Independence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cord Injury ◽  
Over Time

Abstract Study design Multicenter observational study. Objective To describe the long-term outcome of functional independence and quality of life (QoL) for individuals with traumatic and ischemic SCI beyond the first year after injury. Setting A multicenter study in Germany. Methods Participants of the European multicenter study about spinal cord injury (EMSCI) of three German SCI centers were included and followed over time by the German spinal cord injury cohort study (GerSCI). Individuals’ most recent spinal cord independence measure (SCIM) scores assessed by a clinician were followed up by a self-report (SCIM-SR) and correlated to selected items of the WHO short survey of quality of life (WHO-QoL-BREF). Results Data for 359 individuals were obtained. The average time passed the last clinical SCIM examination was 81.47 (SD 51.70) months. In total, 187 of the 359 received questionnaires contained a completely evaluable SCIM-SR. SCIM scores remained stable with the exception of reported management of bladder and bowel resulting in a slight decrease of SCIM-SR of −2.45 points (SD 16.81). SCIM-SR scores showed a significant correlation with the selected items of the WHO-QoL-BREF (p < 0.01) with moderate to strong influence. Conclusion SCIM score stability over time suggests a successful transfer of acquired independence skills obtained during primary rehabilitation into the community setting paralleled by positively related QoL measurements but bladder and bowel management may need special attention.

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