Conservative and Surgical Management of Spinal Cord Cavernous Malformations.
Conservative and Surgical Management of Spinal Cord Cavernous Malformations.
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DOI：
10.1016/j.wnsx.2019.100066
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Kishima, Haruhiko
中科院分区：
文献类型：
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作者：
Ohnishi, Yu-Ichiro;Nakajima, Nobuhiko;Kishima, Haruhiko
目的：我们提出了一系列的脊髓海绵状血管畸形（SCCMs）的临床表现和结果的手术和保守management.METHODS：在我们的机构诊断为SCCMs的患者的临床过程进行了回顾性分析。神经系统症状采用改良McCormick量表进行评估。5例患者（27.8%）出现急性发作出血，其中4例立即手术切除。13例患者（72.2%）最初接受保守治疗。8例患者（38.9%）在随访期间发生出血，8例（38.9%）因出血或神经功能恶化需要手术切除。从最初症状到随后出血或症状恶化的平均（范围）持续时间为1.42（范围：0.25-4.33）年。从主要症状到手术的平均持续时间为2.10年（范围：0.25-5.0）。无患者在手术切除后发生后续出血。手术组11例患者（84.6%）神经功能状态改善，2例患者（15.4%）保持不变。随后的年出血风险为3.7%。即刻手术组患者的病变明显大于保守组。最差的改良麦考密克量表等级之间的衰弱症状的时间和出血的长度，但不是大小的lesions.CONCLUSIONS：SCCMs手术导致没有复发的出血或神经系统症状的加重，并应考虑在随访期间发生急性出血或衰弱症状的患者。
OBJECTIVES: We present a case series of spinal cord cavernous malformations (SCCMs) to describe clinical presentation and outcomes of both surgical and conservative management.METHODS: The clinical courses of patients diagnosed with SCCMs at our institution were retrospectively reviewed. Neurologic symptoms were evaluated using the Modified McCormick Scale.RESULTS: A total of 18 patients were identified. Five patients (27.8%) presented with acute onset bleeding, 4 of whom underwent immediate surgical resection. Thirteen patients (72.2%) were initially managed conservatively. Eight patients (38.9%) developed a hemorrhage during follow-up, and 8 (38.9%) required surgical resection due to bleeding or neurological worsening. The mean (range) duration from primary symptoms to subsequent hemorrhage or deterioration of symptoms was 1.42 (range: 0.25-4.33) years. The mean duration from primary symptoms to surgery was 2.10 (range: 0.25-5.0) years. No patients experienced subsequent hemorrhage after surgical resection. Eleven patients (84.6%) in the surgery group showed improved neurological status, and 2 patients (15.4%) remained unchanged. The annualized subsequent hemorrhage risk was 3.7%. Patients in the immediate surgical group had a significantly larger lesion compared with those in the conservative group. There was significance between the worst Modified McCormick Scale grades at the time of debilitating symptoms and the length of hemorrhage, but not the size of the lesion.CONCLUSIONS: Surgery for SCCMs resulted in no recurrence of hemorrhage or exacerbation of neurological symptoms, and should be considered for patients who experienced acute onset of hemorrhage or debilitating symptoms during follow-up.