A systematic review on the outcome of intramedullary spinal cord cavernous malformations

Eur Spine J. 2022 Nov;31(11):3119-3129. doi: 10.1007/s00586-022-07332-6. Epub 2022 Aug 6.


Purpose: This study aimed to investigate the neurological outcome, trends and sequelae following surgical or conservative treatment of intramedullary spinal cord cavernous malformations (ISCCMs).

Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measure was the change in the neurological status after surgery or conservative management. A logistic regression analysis investigating prognostic factors related to outcome was also performed.

Results: Twenty-one studies with 1091 patients in total were included, of which 1005 (92.1%) underwent surgical resection and 86 (7.9%) were treated conservatively. Gross total resection was achieved in 95.7% of the patients and partial resection in 4.3%. Most lesions (60.2%) were located in the thoracic spine and presented with motor (60.4%) and sensory deficits (59.7%). In the long term, surgical treatment resulted in an improved neurological status in 36.9% of the patients, in 55.8% it remained stable, and in 7.3% it deteriorated compared to the preoperative state. In the conservative cohort, 21.7% improved, 69.6% remained stable, and 8.7% deteriorated. Solitary lesions, duration of preoperative symptoms less than 3 months as well as an improved post-operative neurological status were predictors of a favourable long-term outcome.

Conclusions: Whenever feasible, symptomatic patients with ISCCM are recommended to undergo surgery within 3 months from symptom onset. Absence of multiple lesions and, most importantly, post-operative symptom improvement foresee a favourable long-term outcome. Further research is warranted to discern the role of conservative treatment in symptomatic patients.

Keywords: Intramedullary lesions; Management; Neurological outcome; Prognostic factors; Spinal cord cavernoma.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Follow-Up Studies
  • Humans
  • Nervous System Malformations*
  • Neurosurgical Procedures / methods
  • Retrospective Studies
  • Spinal Cord / surgery
  • Spinal Cord Neoplasms* / diagnostic imaging
  • Spinal Cord Neoplasms* / pathology
  • Spinal Cord Neoplasms* / surgery
  • Treatment Outcome