Treatment of Spinal Cavernous Malformations: A Single-Center Case Series

Cavernous malformations (CMs) are benign vascular lesions composed of clusters of dilated, thin-walled, blood-filled vessels. The prevalence of CMs in the general population ranges from 0.4%-0.9%, with the majority located in the brain, while spinal cord CMs represent rare subtypes. Spinal CMs are clinically significant due to their potential for symptomatic hemorrhage, leading to neurological deficits. Although rare, they have attracted increasing attention in the literature. Thereby both, intramedullary hemorrhage and spinal cord surgery bear the risk of injury. This case series reports functional outcomes following surgical and conservative treatment of spinal CMs.

In this retrospective case series, we analyzed all patients with spinal CMs from 2010-2023 at our tertiary center. Functional outcome was determined based on the modified Rankin and McCormick Scale.

Fifty-two patients with a median age of 54 (interquartile range: 43-60) years and a female-to-male ratio of 1:4 were included. Thirty-five (67.0%) of the patients received surgical treatment of the lesion via a posterior approach through (hemi-)laminectomy or laminoplasty with no mortality to report. The morbidity rate was 17.1%. Hereby, the patients report mainly surgery-related new sensitivity deficits. The univariate analysis revealed no independent risk factors concerning the occurrence of surgery-related morbidity. The surgically treated patients showed an improvement between preoperative and follow-up functional outcome.

Spinal CMs can be safely managed through surgical resection, with a relatively low morbidity rate and no reported mortality. Our results demonstrate that postoperative morbidity was predominantly characterized by sensory deficits, while motor deficits were less common.