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首页> 外文期刊>Neurosurgical focus >Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients
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Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients

机译：手术和保守治疗有症状脊髓海绵状畸形的预后因素：一系列20例患者的审查

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Object In this study, the authors present a review of a series of 20 intramedullary spinal cord cavernous malformations (SCCMs) with particular focus on MR imaging and prognostic factors. Methods Between 1994 and 2009, 20 patients with SCCM were treated under the care of the senior author. The diagnosis was made in all patients after the onset of clinical symptoms. The age of the 9 men and 11 women ranged between 26 and 71 years (median 38.5 years). The duration of symptoms prior to referral ranged from 1 week to 9 years (median 6.5 months). At the time of referral, 4 patients had no significant neurological deficits, 10 patients suffered significant functional restrictions, and 6 patients presented with severe paraparesis and loss of functional strength. None of the patients had complete paraplegia. Seventeen patients underwent microsurgical removal, while 3 patients opted for conservative therapy. For the present analysis, the medical records and MR images and/or reports were reviewed. Classification of length of history, pretreatment status, MR imaging pattern, and treatment modality was done and correlated with outcome. Results The cavernoma was located at the cervical level in 8 patients and between T-1 and L-1 in 12 patients. The cavernoma appeared as mainly T2 hyperintense on MR images in 7 patients, mainly T2 hypointense in 2 patients, and mixed in the remaining 10 patients. The craniocaudal extension of the core varied between 5 and 45 mm. In 2 patients with cervical cavernomas, a distinct T2 signal of the spinal cord cranial and distal to the cavernoma was seen, and in a patient with a large thoracic cavernoma, T2 extinction cranial and caudal to the cavernoma was seen as a sign of hemosiderosis. Neurological deficits improved postoperatively in 12 of the surgically treated patients, remained stable in 2, and deteriorated in 3. The 3 patients who were conservatively treated remained stable over a follow-up of 3–9 years. Postoperative improvement was seen in 5 of 7 surgical patients with a history of symptoms of 2 months or less, 5 of 6 patients with a history of 2–24 months, and in 2 of 4 patients with a history of more than 2 years. Two of the 3 patients with postoperative deterioration had a history of more than 2 years and the third a short history of 1 month. Conclusions Although a satisfactory outcome can be achieved through surgical treatment of SCCMs, some patients worsen after surgery or during the postoperative course. Long-term stability is possible in oligosymptomatic conservatively treated patients. The prevalence and pathophysiological importance of segmental spinal cord edema and hemosiderosis is incompletely understood at the present time.
机译：目的在本研究中，作者对一系列20例髓内脊髓海绵状畸形（SCCM）进行了综述，特别关注MR成像和预后因素。方法1994年至2009年，在资深作者的护理下对20例SCCM患者进行了治疗。在临床症状发作后对所有患者进行诊断。 9名男性和11名女性的年龄在26至71岁之间（中位数为38.5岁）。转诊前症状的持续时间为1周至9年（中位数6.5个月）。转诊时，4例患者无明显神经功能缺损，10例患者出现明显的功能受限，6例患者出现严重的轻瘫和功能强度下降。所有患者均无完全性截瘫。 17例患者接受了显微手术切除，而3例患者选择了保守治疗。对于本分析，对病历和MR图像和/或报告进行了审查。完成病史长度，治疗前状态，MR成像模式和治疗方式的分类，并将其与结果相关联。结果8例海绵体瘤位于宫颈水平，12例位于T-1和L-1之间。在7例MR图像中，海绵状瘤主要表现为T2高信号，2例主要表现为T2低点，其余10例混合出现。核心的颅尾延伸范围在5至45毫米之间。在2例宫颈海绵状瘤患者中，可以看到脊髓颅骨和海绵体远端的明显T2信号，而在一个胸大的海绵体瘤患者中，海绵体瘤的T2灭绝的颅骨和尾部被视为含铁血黄素沉着症的信号。接受手术治疗的患者中有12例术后神经功能缺损得到改善，有2例保持稳定，有3例恶化。在接受3至9年的随访后，接受保守治疗的3例患者保持稳定。病史为2个月或更短的7例外科手术患者中有5例，病史为2-24个月的6例患者中有5例，病史超过2年的4例患者中有2例为术后改善。 3例术后恶化的患者中有2例病史超过2年，第3例病史短于1个月。结论尽管通过SCCM的手术治疗可以取得令人满意的结果，但仍有一些患者在手术后或术后病情恶化。保守治疗的有症状患者可长期稳定。目前尚不完全了解节段性脊髓水肿和铁血黄素沉着症的患病率和病理生理学重要性。

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