The current management of spinal cord cavernoma.

BACKGROUND: Spinal cavernous malformations (SCM) were once thought to be rare lesions of the spinal cord. However, with the broad use of modern imaging techniques the incidence of SCM has significantly increased over the last decades. Management of both symptomatic and incidental findings is therefore of growing importance. However, experience with treatment and follow-up is very limited.

METHODS: We performed a single institution retrospective review of consecutive patients with SCM treated at our Department between 2006-2016 and discuss the clinical features as well as surgical versus conservative outcomes. We further provide a systematic literature search and discuss the best management of SCM, analyzing recent publications on SCM imaging techniques, surgical approaches and natural history.

RESULTS: From a total number of 406 consecutive patients with cavernous malformations (CM) treated at our Department between 2006-2016, 29 (7.1%) were found to be affected by SCM. The localization was cervical in 10 (34.5%), cervicothoracic in 3 (10.4%) and thoracic in 16 (55.2%) patients. In 90% of patients (N.=26) the diagnosis was made after onset of clinical symptoms. Conservative management was performed for 8 patients, whereas 21 patients underwent surgical removal of the lesion via a posterior approach using (hemi-) laminectomy or laminoplasty. Functional status improved in 15 patients (62.5%) and remained unchanged in 6 patients (28.5%) in the operative group, whereas 2 patients (25%) improved and 6 patients (75%) remained unchanged in the conservative group during long-term follow-up.

CONCLUSIONS: Gross-total resection is the only definitive treatment option for symptomatic SCM. Surgical extirpation of the symptomatic SCM lesion through an unilateral laminectomy (=hemilaminectomy) approach within 3 months of presentation seems to be good treatment option with an acceptable risk of complications and good long-term outcomes. Conservative treatment should be performed in asymptomatic patients and seems to be an option as well in elderly patients and if patients' symptoms at diagnosis are mild and do not show progression over time.