Cervical Intramedullary Cavernoma in Children: case report and literature review

Abstract

Case presentation: A 10-year-old male patient was admitted due to posterior cervicalgia, vomiting and progressive generalizedweakness. Physical examination showed difficulty in ambulation and tetraparesis. Gadolinium-loaded magnetic resonance imaging(MRI) of the cervical medulla, showed a poorly contrasted mass with a hemorrhagic center. We undertook a posterior cervicotomy(C1-C3). Post-operative evolution was satisfactory with complete regression of the deficits 90 days after the surgery. Control MRIat intervals of 1 and 4 years confirmed absence of the tumor. Discussion: Cavernomas are vascular malformations, consisting ofcoarsely dilated vascular channels and coated by a single layer of endothelial cells, devoid of endothelium and myothelium. Theyrepresent only 5-12% of all vascular pathologies of the medulla, with only 10% affecting the pediatric population. There are onlythirty cases of pediatric intramedullary spinal cavernomas in the literature, with predominance among males (2.1:1). Thoracic andcervical spinal cavernomas consist in 55% and 45% of the cases, respectively. In six cases (20%) cavernomatous lesions were associatedwith synchronic intracranial cavernoma. Among the reported cases, only one had poor evolution after surgery, whereas six patientspersisted with prior symptoms. Conclusion: Spinal intramedullary cavernomas are rare entities, especially in the pediatric population,and are treated with surgery which improves prior neurologic deficits, besides preventing rebleeding.