Abstract
Objective There is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management. Methods We retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates. Results A total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1-12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013). Conclusion Large, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 695-703 |
| Number of pages | 9 |
| Journal | Journal of Neurology, Neurosurgery and Psychiatry |
| Volume | 90 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2019 |
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Keywords
- bleeding risk
- cavernoma
- cavernous malformation
- hemorrhage
- intramedullary
- natural history
- neurologic outcomes
- spinal cord
- surgical resection
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
- Psychiatry and Mental health
Cite this
Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations. / Goyal, Anshit; Rinaldo, Lorenzo; Alkhataybeh, Redab; Kerezoudis, Panagiotis; Alvi, Mohammed Ali; Flemming, Kelly; Williams, Lindsy; Diehn, Felix; Bydon, Mohamad.
In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 90, No. 6, 01.06.2019, p. 695-703.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations
AU - Goyal, Anshit
AU - Rinaldo, Lorenzo
AU - Alkhataybeh, Redab
AU - Kerezoudis, Panagiotis
AU - Alvi, Mohammed Ali
AU - Flemming, Kelly
AU - Williams, Lindsy
AU - Diehn, Felix
AU - Bydon, Mohamad
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objective There is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management. Methods We retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates. Results A total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1-12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013). Conclusion Large, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening.
AB - Objective There is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management. Methods We retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates. Results A total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1-12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013). Conclusion Large, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening.
KW - bleeding risk
KW - cavernoma
KW - cavernous malformation
KW - hemorrhage
KW - intramedullary
KW - natural history
KW - neurologic outcomes
KW - spinal cord
KW - surgical resection
UR - http://www.scopus.com/inward/record.url?scp=85061658600&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061658600&partnerID=8YFLogxK
U2 - 10.1136/jnnp-2018-319553
DO - 10.1136/jnnp-2018-319553
M3 - Article
VL - 90
SP - 695
EP - 703
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
SN - 0022-3050
IS - 6
ER -