407 Residual and Recurrent Spinal Cord Cavernous Malformations: Outcomes and Technical Notes for Optimal Resection

Abstract

INTRODUCTION: Intramedullary spinal cord cavernous malformations (SCCMs) account for a small proportion (5%) of CMs overall and of spinal vascular malformations. However, they are well reported in the literature, with over 700 cases as of 2020. To date, the occurrence of recurrent or residual SCCMs has not been assessed or discussed, nor have the technical nuances of resection related to this issue. METHODS: An institutional database of vascular malformations was queried for all surgically managed cases of intramedullary cavernous malformations. Demographic, radiologic, intraoperative findings, and surgical outcomes data were obtained and retrospectively analyzed. A systematic review was performed using three databases (PubMed, Ovid MEDLINE, and Scopus) to analyze all cases of spinal cavernous malformations in the literature, to augment a prior review. RESULTS: 146 cases of SCCM surgeries were identified in the database, including 17 recurrent lesions. Recurrences occurred at various time points, from as few as 3 to 264 months following initial resection. At the postoperative exam, 10 patients had better outcome scores than preoperative scores, 1 of which was status post resection of a recurrent lesion. A total of 21 patients had worse outcome scores, 4 of which were status post resection of recurrent lesion. CONCLUSION: Intramedullary spinal cord cavernous malformations are rare findings but may cause significant symptoms. Resection of these lesions is technically challenging, akin to the resection of brainstem cavernous malformations. Care should be taken to avoid leaving residual lesion, as this can leave the patient vulnerable to future hemorrhagic events and neurological morbidity. Satisfactory results are still achievable even with secondary or tertiary resections.