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Tumori spinali intradurali. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Koshimizu H, Ando K, Kobayashi K, Nakashima H, Machino M, Ito S, Kanbara S, Inoue T, Yamaguchi H, Imagama S. Intramedullary cavernous hemangioma of the spinal cord with intra- and extramedullary hematomas. J Orthop Sci 2020:S0949-2658(20)30290-6. [PMID: 33160819 DOI: 10.1016/j.jos.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroyuki Koshimizu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Taro Inoue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hidetoshi Yamaguchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Shih RY, Koeller KK. Intramedullary Masses of the Spinal Cord: Radiologic-Pathologic Correlation. Radiographics 2020; 40:1125-1145. [PMID: 32530746 DOI: 10.1148/rg.2020190196] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spinal cord tumors are a challenge for patients and neurosurgeons because of the high risk of neurologic deficits from the disease process and surgical interventions. Spinal cord tumors are uncommon, and approximately 2%-3% of primary intra-axial tumors of the central nervous system occur in the spinal cord. Primary intra-axial tumors are usually derived from neuroepithelial tissue, especially glial cells. This often leads to a classic intramedullary mass differential diagnosis of ependymoma or astrocytoma, which together constitute up to 70% of spinal cord tumors. For example, ependymomas occur predominantly in adults, and astrocytomas (specifically pilocytic astrocytomas) occur predominantly in children. While that is an excellent starting point, in order to refine the differential diagnosis, the authors review the radiologic-pathologic features of specific neoplastic categories and entities recognized by the World Health Organization (WHO) in the 2016 WHO Classification of Tumours of the Central Nervous System and a few additional congenital-developmental entities. Radiologists can add value by providing a reasonable preoperative differential diagnosis for the patient and neurosurgeon, in many cases by favoring the most common conditions, and in other cases by identifying radiologic features that may point toward a less common entity. Some of the less common entities include intramedullary myxopapillary ependymoma, spinal subependymoma, and spinal hemangioblastoma. Whenever possible, the characteristic imaging features and locations of these tumors are explained or traced back to the underlying cell of origin and findings seen at histopathologic examination.See discussion on this article by Buch.
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Affiliation(s)
- Robert Y Shih
- From the Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (R.Y.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
| | - Kelly K Koeller
- From the Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (R.Y.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
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Panda A, Diehn FE, Kim DK, Bydon M, Goyal A, Benson JC, Carr CM, Rinaldo L, Flemming KD, Lanzino G. Spinal Cord Cavernous Malformations: MRI Commonly Shows Adjacent Intramedullary Hemorrhage. J Neuroimaging 2020; 30:690-696. [PMID: 32462668 DOI: 10.1111/jon.12738] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE There is a relative paucity of radiology literature on spinal cord cavernous malformations (SCMs). We hypothesized that the classic MRI features of cavernous malformations are not highly prevalent. The purpose was to review MR imaging findings of SCMs with a focus on prevalence of hemorrhagic features, including adjacent intramedullary hemorrhage at initial presentation. METHODS In this single-institution study, 78 SCMs in 76 patients diagnosed on imaging/pathology were retrospectively evaluated for size, location, cord expansion, exophytic component, popcorn morphology, signal characteristics, including T1 weighted (T1w) and T2w rims, blood-fluid levels, and adjacent intramedullary hemorrhage. Intramedullary hemorrhage was defined as centrally and/or eccentrically located linear or flame shaped non-edematous signal abnormality extending longitudinally away from SCMs, distinct from lesional rim. RESULTS Sixty-three percent (49/78) of SCMs measured <1 cm in length, 78% (61/78) extended to the cord surface, 65% (51/78) were expansile, and 32% (25/78) were exophytic. Popcorn morphology was seen in 15% (12/78) on T1w and 22% (17/78) on T2w. Internal blood-fluid levels were evident in 4% (3/78). Sixty-nine percent (54/78) showed T2w hypointense rims; the T2w rim was complete/near-complete in 37% (29/78). A rim on T1w was visible in 49% (38/78); this was hyperintense in 58% (22/38). Adjacent intramedullary hemorrhage was seen in 45/78 (58%), was most commonly bidirectional in 67% (30/45) and eccentric in 68% (30/44). Cord edema was seen in 22% (17/78); 53% (9/17) also demonstrated intramedullary hemorrhage with edema. CONCLUSIONS The classically described popcorn morphology, internal blood-fluid levels, and complete/near-complete T2w hypointense rims are often absent on MRIs in SCMs. Adjacent intramedullary hemorrhage is frequently present, often eccentric and bidirectional.
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Affiliation(s)
- Ananya Panda
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Felix E Diehn
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Dong Kun Kim
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | - Anshit Goyal
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | - John C Benson
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
| | - Carrie M Carr
- Department of Neuroradiology, Mayo Clinic, Rochester, MN
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Kang MG, Kim KH, Park JY, Koo SW, Chin DK, Kim KS, Cho YE. Intramedullary Cavernous Hemangioma with Calcification of Spinal Cord. World Neurosurg 2019; 130:298-303. [DOI: 10.1016/j.wneu.2019.07.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 11/28/2022]
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Ren J, Hong T, He C, Li X, Ma Y, Yu J, Ling F, Zhang H. Surgical approaches and long-term outcomes of intramedullary spinal cord cavernous malformations: a single-center consecutive series of 219 patients. J Neurosurg Spine 2019; 31:123-132. [PMID: 30952112 DOI: 10.3171/2018.12.spine181263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Optimal surgical strategies for intramedullary spinal cord cavernous malformations (ISCCMs) are not optimized and remain problematic. In this study the authors identify rational surgical strategies for ISCCMs and predictors of outcomes after resection. METHODS A single-center study was performed with 219 consecutive surgically treated patients who presented from 2002 to 2017 and were analyzed retrospectively. The American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate neurological functions. Patient characteristics, surgical approaches, and immediate and long-term postoperative outcomes were identified. RESULTS The average ISCCM size was 10.5 mm. The spinal level affected was cervical in 24.8% of patients, thoracic in 73.4%, and lumbar in 1.8%. The locations of the lesions in the horizontal plane were 30.4% ventral, 41.6% dorsal, and 28.0% central. Of the 214 patients included in the cohort for operative evaluation, 62.6% had superficially located lesions, while 37.4% were embedded. Gross-total resection was achieved in 98.1% of patients. The immediate postoperative neurological condition worsened in 10.3% of the patients. Multivariate logistic regression identified mild preoperative function (p = 0.014, odds ratio [OR] 4.5, 95% confidence interval [CI] 1.4-14.8) and thoracolumbar-level lesions (p = 0.01, OR 15.7, 95% CI 1.9-130.2) as independent predictors of worsening. The mean follow-up duration in 187 patients was 45.9 months. Of these patients, 63.1% were stable, 33.2% improved, and 3.7% worsened. Favorable outcomes were observed in 86.1% of patients during long-term follow-up and were significantly associated with preoperative mild neurological and disability status (p = 0.000) and cervically located lesions (p = 0.009). The depths of the lesions were associated with worse long-term outcomes (p = 0.001), and performing myelotomy directly through a yellowish abnormal surface in moderate-depth lesions was an independent predictor of worsening (p = 0.023, OR 35.3, 95% CI 1.6-756.3). CONCLUSIONS Resection performed with an individualized surgical approach remains the primary therapeutic option in ISCCMs. Performing surgery in patients with mild symptoms at the thoracolumbar level and embedded located lesions requires more discretion.
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Pierce JL, Donahue JH, Nacey NC, Quirk CR, Perry MT, Faulconer N, Falkowski GA, Maldonado MD, Shaeffer CA, Shen FH. Spinal Hematomas: What a Radiologist Needs to Know. Radiographics 2018; 38:1516-1535. [DOI: 10.1148/rg.2018180099] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer L. Pierce
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Joseph H. Donahue
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Nicholas C. Nacey
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Cody R. Quirk
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Michael T. Perry
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Nicholas Faulconer
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Gene A. Falkowski
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Michael D. Maldonado
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Catherine A. Shaeffer
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Francis H. Shen
- From the Departments of Radiology and Medical Imaging (J.L.P., J.H.D., N.C.N., C.R.Q., M.T.P., N.F., M.D.M., C.A.S.) and Orthopedic Surgery (G.A.F., F.H.S.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
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Azad TD, Veeravagu A, Li A, Zhang M, Madhugiri V, Steinberg GK. Long-Term Effectiveness of Gross-Total Resection for Symptomatic Spinal Cord Cavernous Malformations. Neurosurgery 2018; 83:1201-1208. [DOI: 10.1093/neuros/nyx610] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/06/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Amy Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Venkatesh Madhugiri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Giammattei L, Messerer M, Prada F, DiMeco F. Intramedullary cavernoma: A surgical resection technique. Neurochirurgie 2017; 63:426-429. [DOI: 10.1016/j.neuchi.2016.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/11/2016] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
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Saliou G, Krings T. Vascular diseases of the spine. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:707-16. [PMID: 27430437 DOI: 10.1016/b978-0-444-53486-6.00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Badhiwala JH, Farrokhyar F, Alhazzani W, Yarascavitch B, Aref M, Algird A, Murty N, Kachur E, Cenic A, Reddy K, Almenawer SA. Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data. J Neurosurg Spine 2014; 21:662-76. [DOI: 10.3171/2014.6.spine13949] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Information pertaining to the natural history of intramedullary spinal cord cavernous malformations (ISCCMs) and patient outcomes after surgery is scarce. To evaluate factors associated with favorable outcomes for patients with surgically and conservatively managed ISCCMs, the authors performed a systematic review and metaanalysis of the literature. In addition, they included their single-center series of ISCCMs.
Methods
The authors searched MEDLINE, EMBASE, CINAHL, Google Scholar, and The Cochrane Library for studies published through June 2013 that reported cases of ISCCMs. Data from all eligible studies were used to examine the epidemiology, clinical features, and neurological outcomes of patients with surgically managed and conservatively treated ISCCMs. To evaluate several variables as predictors of favorable neurological outcomes, the authors conducted a meta-analysis of individual patient data and performed univariate and multivariate logistic regression analyses. Variables included patient age, patient sex, lesion spinal level, lesion size, cerebral cavernomas, family history of cavernous malformations, clinical course, presenting symptoms, treatment strategy (operative or conservative), symptom duration, surgical approach, spinal location, and extent of resection. In addition, they performed a meta-analysis to determine a pooled estimate of the annual hemorrhage rate of ISCCMs.
Results
Eligibility criteria were met by 40 studies, totaling 632 patients, including the authors' institutional series of 24 patients. Mean patient age was 39.1 years (range 2–80 years), and the male-to-female ratio was 1.1:1. Spinal levels of cavernomas were cervical (38%), cervicothoracic (2.4%), thoracic (55.2%), thoracolumbar (0.6%), lumbar (2.1%), and conus medullaris (1.7%). Average cavernoma size was 9.2 mm. Associated cerebral cavernomas occurred in 16.5% of patients, and a family history of cavernous malformation was found for 11.9% of evaluated patients. Clinical course was acute with stepwise progression for 45.4% of patients and slowly progressive for 54.6%. Symptoms were motor (60.5%), sensory (57.8%), pain (33.8%), bladder and/or bowel (23.6%), respiratory distress (0.5%), or absent (asymptomatic; 0.9%). The calculated pooled annual rate of hemorrhage was 2.1% (95% CI 1.3%–3.3%). Most (89.9%) patients underwent resection, and 10.1% underwent conservative management (observation). Outcomes were better for those who underwent resection than for those who underwent conservative management (OR 2.79, 95% CI 1.46–5.33, p = 0.002). A positive correlation with improved neurological outcomes was found for resection within 3 months of symptom onset (OR 2.11, 95% CI 1.31–3.41, p = 0.002), hemilaminectomy approach (OR 3.20, 95% CI 1.16–8.86, p = 0.03), and gross-total resection (OR 3.61, 95% CI 1.24–10.52, p = 0.02). Better outcomes were predicted by an acute clinical course (OR 1.72, 95% CI 1.10–2.68, p = 0.02) and motor symptoms (OR 1.76, 95% CI 1.08–2.86, p = 0.02); poor neurological recovery was predicted by sensory symptoms (OR 0.58, 95% CI 0.35–0.98, p = 0.04). Rates of neurological improvement after resection were no higher for patients with superficial ISCCMs than for those with deep-seated ISCCMs (OR 1.36, 95% CI 0.71–2.60, p = 0.36).
Conclusions
Intramedullary spinal cord cavernous malformations tend to be clinically progressive. The authors' findings support an operative management plan for patients with a symptomatic ISCCM. Surgical goals include gross-total resection through a more minimally invasive hemilaminectomy approach within 3 months of presentation.
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Affiliation(s)
| | - Forough Farrokhyar
- 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Alhazzani
- 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Mohammed Aref
- 1Division of Neurosurgery, Department of Surgery, and
| | | | - Naresh Murty
- 1Division of Neurosurgery, Department of Surgery, and
| | - Edward Kachur
- 1Division of Neurosurgery, Department of Surgery, and
| | - Aleksa Cenic
- 1Division of Neurosurgery, Department of Surgery, and
| | - Kesava Reddy
- 1Division of Neurosurgery, Department of Surgery, and
| | - Saleh A. Almenawer
- 1Division of Neurosurgery, Department of Surgery, and
- 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Grasso G, Alafaci C, Granata F, Cutugno M, Salpietro FM, Tomasello F. Thoracic spinal cord cavernous angioma: a case report and review of the literature. J Med Case Rep 2014; 8:271. [PMID: 25106882 PMCID: PMC4141667 DOI: 10.1186/1752-1947-8-271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/11/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction Cavernous angiomas of the spinal cord are rare vascular malformations, which account for approximately 5 to 12 percent of spinal cord vascular lesions. They usually originate in the vertebrae, with occasional extension into the extradural space, and intramedullary cavernomas, even if reported in the literature, are very rare. Case presentation We report the case of a 34-year-old Caucasian woman affected by a thoracic intramedullary cavernous angioma. Our patient complained of 10-day history of acute dorsal pain, progressive weakness of both lower extremities, worse on the right side, a ‘pins and needles’ sensation in the abdominal region and bladder dysfunction. Magnetic resonance imaging showed, at D5 level, a vascular malformation, which was not documented at spinal angiography. Our patient underwent surgical treatment with total removal of the lesion and her symptoms gradually improved. A histological examination revealed the typical features of a cavernous angioma. Conclusions Intramedullary cavernous angioma is a rare lesion that should be diagnosed early and surgically treated before rebleeding or enlargement of the lesion can occur.
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Affiliation(s)
- Giovanni Grasso
- Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, School of Medicine, Via del Vespro 129, Palermo 90100, Italy.
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Abstract
Vascular disease affecting the spinal can cause substantial neurologic morbidity. Several vascular spinal cord ailments present as neurologic emergencies, and should thus be recognizable to the practicing neurologist. We review the epidemiology, presentation, management strategies, and prognosis of various pathologies, including infarction, dural arteriovenous fistula, arteriovenous malformation, cavernous malformation, compressive epidural hematoma, vasculitis, and genetic abnormalities.
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Affiliation(s)
- Mark N Rubin
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Pearl MS, Chen JX, Gregg L, San Millàn D, Belzberg A, Jallo G, Gailloud P. Angiographic detection and characterization of "cryptic venous anomalies" associated with spinal cord cavernous malformations using flat-panel catheter angiotomography. Neurosurgery 2012; 71:125-32. [PMID: 22596040 DOI: 10.1227/neu.0b013e31825d8f9a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Spinal cord cavernous malformations (CMs) are associated with 2 types of angiographically occult "cryptic venous anomalies," which differ in location with respect to the spinal cord. The anatomic distinction between superficial and intramedullary is important in that the latter heighten the risks of CM resection. OBJECTIVE To report the observations of both types of cryptic venous anomalies documented during spinal digital subtraction angiography enhanced with flat-panel catheter angiotomography (FPCA). METHODS Spinal digital subtraction angiography enhanced with FPCA was performed in 2 adult patients with magnetic resonance imaging--documented intramedullary spinal cord CMs and prominent, nonspecific flow voids at the same levels. FPCA was obtained by selective injection of left T4 (case 1) and left T9 (case 2) with 5F Cobra 2 catheters (Terumo, Japan) during a 20-second rotational acquisition. Thirty milliliters of a 75% saline and 25% contrast solution (Omnipaque 300; GE) was administered. The rotational data set was reconstructed on a dedicated workstation (Leonardo; Siemens, Erlangen, Germany) through the use of regular and high-resolution matrixes, 0.4- and 0.1-mm voxel size, respectively. RESULTS Spinal digital subtraction angiography was unremarkable in both cases. In case 1, FPCA findings indicated an atypical network of prominent posterior perimedullary veins. In case 2, FPCA identified radially oriented channels forming a caput medusae pattern collecting into an enlarged intramedullary vein. CONCLUSION The unique ability of FPCA to image the spinal venous system enables the angiographic detection and characterization of abnormal spinal veins associated with CMs. Differentiating between the types of associated cryptic venous malformations may aid in surgical planning because the intramedullary type is associated with a higher risk of surgical complication.
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Affiliation(s)
- Monica S Pearl
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Yilmaz U. [Spinal vascular malformations]. Radiologe 2012; 52:424-9. [PMID: 22584478 DOI: 10.1007/s00117-011-2295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spinal vascular malformations are a group of rare diseases with different clinical presentations ranging from incidental asymptomatic findings to progressive tetraplegia. This article provides an overview about imaging features as well as clinical and therapeutic aspects of spinal arteriovenous malformations, cavernomas and capillary telangiectasia.
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Affiliation(s)
- U Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Homburg/Saar.
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CNS cavernous haemangioma: “popcorn” in the brain and spinal cord. Clin Radiol 2012; 67:380-8. [DOI: 10.1016/j.crad.2011.10.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/10/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022]
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Bozinov O, Burkhardt JK, Woernle CM, Hagel V, Ulrich NH, Krayenbühl N, Bertalanffy H. Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations. Neurosurg Rev 2011; 35:269-75; discussion 275. [DOI: 10.1007/s10143-011-0364-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/28/2011] [Accepted: 09/25/2011] [Indexed: 11/30/2022]
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Abstract
Although originally the subject of rare case reports, intramedullary spinal cord cavernous malformations (CMs) have recently surfaced in an increasing number of case series and natural history reports in the literature. The authors reviewed 27 publications with 352 patients to consolidate modern epidemiological, natural history, and clinical and surgical data to facilitate decision making when managing these challenging vascular malformations. The mean age at presentation was 42 years without a sex predilection. Thirty-eight percent of the cases were cervical, 57% thoracic, 4% lumbar, and 1% unspecified location. Nine percent of the patients had a family history of CNS CMs. Twenty-seven percent of the patients had an associated cranial CM. On presentation 63% of the patients had motor deficits, 65% had sensory deficits, 27% had pain, and 11% had bowel or bladder dysfunction. Presentation was acute in 30%, recurrent in 16%, and progressive in 54% of cases. An overall annual hemorrhage rate was calculated as 2.5% for 92 patients followed up for a total of 2571 patient-years. Across 24 reviewed surgical series, a 91% complete resection rate was found. Transient morbidity was seen in 36% of cases. Sixty-one percent of patients improved, 27% were unchanged, and 12% were worse at the long-term follow-up. Using this information, the authors review surgical nuances in treating these lesions and propose a management algorithm.
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Affiliation(s)
- Bradley A Gross
- Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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21
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Vascular Malformations of the Spine and Spinal Cord*. Clin Neuroradiol 2010; 20:5-24. [DOI: 10.1007/s00062-010-9036-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Accepted: 12/17/2009] [Indexed: 12/16/2022]
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22
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Krings T, Lasjaunias P, Geibprasert S, Hans F, Thron A, TerBrugge K, Reinges M. Classification of Spinal Vascular Malformations. Neuroradiol J 2009. [DOI: 10.1177/19714009090220s118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. Their classification depends on the differentiation of shunting versus non-shunting lesions, the latter being the spinal cord cavernomas. In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries (i.e. the counterparts of meningeal arteries in the brain) constitute the dural arteriovenous fistulas, the shunts that are fed by arteries that would normally supply the spinal cord (i.e. the radiculomedullary and radiculopial arteries) are the pial cord arteriovenous malformations (whose cranial counterparts are the brain AVMs). Depending on the type of transition between artery and vein the latter pial AVMs can be further subdivided into glomerular (plexiforme or nidus-type) AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs. The last step in the classification then describes whether the type of fistula has a high or a low shunting volume which will differentiate the “Macro-” from the “Micro-”fistulae. The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus-architecture and its flow-volume evaluation. The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.
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Affiliation(s)
- T. Krings
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital; Toronto, Ontario, Canada
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital de Bicetre, Le Kremlin-Bicetre; Paris, France
- Department of Neuroradiology, University Hospital Aachen; Aachen, Germany
| | - P.L. Lasjaunias
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital de Bicetre, Le Kremlin-Bicetre; Paris, France
| | - S. Geibprasert
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital de Bicetre, Le Kremlin-Bicetre; Paris, France
- Department of Diagnostic Radiology, the Hospital for Sick Children, University of Toronto; Toronto, Ontario, Canada
| | - F.J. Hans
- Clinic for Neurosurgery, University Hospital Aachen; Aachen Germany
| | - A.K. Thron
- Department of Neuroradiology, University Hospital Aachen; Aachen, Germany
| | - K.G. TerBrugge
- Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital; Toronto, Ontario, Canada
| | - M.H.T. Reinges
- Clinic for Neurosurgery, University Hospital Aachen; Aachen Germany
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23
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Bian L, Bertalanffy H, Sun Q, Shen JK. Intramedullary cavernous malformations: Clinical features and surgical technique via hemilaminectomy. Clin Neurol Neurosurg 2009; 111:511-7. [DOI: 10.1016/j.clineuro.2009.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 12/11/2008] [Accepted: 02/07/2009] [Indexed: 10/21/2022]
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24
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Intradural spinal tumors: current classification and MRI features. Neuroradiology 2007; 50:301-14. [PMID: 18084751 DOI: 10.1007/s00234-007-0345-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 11/16/2007] [Indexed: 10/22/2022]
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25
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Krings T, Lasjaunias PL, Hans FJ, Mull M, Nijenhuis RJ, Alvarez H, Backes WH, Reinges MHT, Rodesch G, Gilsbach JM, Thron AK. Imaging in spinal vascular disease. Neuroimaging Clin N Am 2007; 17:57-72. [PMID: 17493539 DOI: 10.1016/j.nic.2007.01.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Spinal vascular diseases are rare and constitute only 1% to 2% of all vascular neurologic pathologies. In this article, the following vascular pathologies of the spine are described: spinal arterial infarcts, spinal cavernomas, and arteriovenous malformations (including perimedullary fistulae and glomerular arterivenous malformations), and spinal dural arteriovenous fistulae. This article gives an overview about their imaging features on MRI, MR angiography, and digital subtraction angiography. Clinical differential diagnoses, the neurologic symptomatology, and the potential therapeutic approaches of these diseases, which might vary depending on the underlying pathologic condition, are given.
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Affiliation(s)
- Timo Krings
- Department of Neuroradiology, University Hospital Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
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26
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Krings T, Mull M, Gilsbach JM, Thron A. Spinal vascular malformations. Eur Radiol 2004; 15:267-78. [PMID: 15538580 DOI: 10.1007/s00330-004-2510-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 08/16/2004] [Accepted: 08/19/2004] [Indexed: 12/16/2022]
Abstract
Spinal vascular malformations are rare diseases that consist of true inborn cavernomas and arteriovenous malformations (including perimedullary fistulae, glomerular and juvenile AVMs) and presumably acquired dural arteriovenous fistulae. This review article gives an overview of the imaging features both on MRI and angiography, the differential diagnoses, the clinical symptomatology and the potential therapeutic approaches to these diseases. It is concluded that MRI is the diagnostic modality of first choice in suspected spinal vascular malformation and should be complemented by selective spinal angiography. Treatment in symptomatic patients offers an improvement in the prognosis, but should be performed in specialized centers. Patients with spinal cord cavernomas and perimedullary fistulae type I are surgical candidates. Dural arteriovenous fistulae can either be operated upon or can be treated by an endovascular approach, the former being a simple, quick and secure approach to obliterate the fistula, while the latter is technically demanding. In spinal arteriovenous malformations, the endovascular approach is the method of first choice; in selected cases, a combined therapy might be sensible.
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Affiliation(s)
- Timo Krings
- Department of Neuroradiology, University Hospital Aachen, Pauwelsstrasse 30, 52057, Aachen, Germany.
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