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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 652-657. doi: 10.19723/j.issn.1671-167X.2023.04.014

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Prognosis of patients with spinal intramedullary cavernous hemangioma by different treatments

Bin CHEN,Chao WU,Bin LIU,Tao YU,Zhen-yu WANG*()   

  1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-10-26 Online:2023-08-18 Published:2023-08-03
  • Contact: Zhen-yu WANG E-mail:wzyu502@126.com

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Abstract:

Objective: To investigate the improvement of spinal cord function in patients with spinal intramedullary cavernous hemangioma (SICH) treated with different methods at the last follow-up. Methods: A retrospective study of 30 patients with SICH in Peking University Third Hospital from January 2007 to December 2018 was conducted. Clinical data of 30 patients were collected including gender, age, clinical symptoms, and imaging manifestations were acquired from their clinical records. Spinal functions of the patients with SICH were evaluated by European myelopathy score (EMS). The functional status of the spinal cord before and after the last follow-up were analyzed. Results: Among the 30 patients, there were 14 male patients and 16 female patients (1 ∶ 1.14). The average age of the patients was (48.1±13.6) years (18-81 years). In the study, 3 cases were sensory disturbance; 2 cases manifested with only decreased muscle strength; 1 case showed simple pain; 1 case manifested with decreased muscle strength and pain; Sensory disturbance accompanied by decreased muscle strength occurred in 5 cases; 3 cases suffered from both sensory disturbance, decreased muscle strength and abnormal defecation; 3 cases suffered from sensory disturbance, decreased muscle strength and pain; 8 cases showed sensory disturbance and pain; 1 case had sensory disturbance, pain and abnormal defecation; 1 case had sensory disturbance, pain, decreased muscle strength and abnormal defecation; 2 cases were asymptomatic. There were 11 patients whose lesions were located in the cervical region, 2 patients located at the cervical-thoracic region, 15 patients located in the thoracic region, and 2 patients located in the lumbar spine. The average maximum diameter of hemangioma was (10.90±4.87) mm. Their magnetic resonance imaging (MRI) features were usually mixed signal and high signal on T2WI, and equal signal or mixed signal on T1WI. A total of 30 patients were followed up for (27.4±8.7) months, including 19 patients with surgical treatment and 11 patients with conservative treatment. The spinal cord function at the last follow up in surgical group was significantly improved. The difference was statistically significant (P < 0.05). Only one patient' s symptom in conservative treatment group improved. However, the symptoms of the two patients aggravated. Other patients remained stable. There was no significant difference in spinal cord function before and after treatment (P>0.05). Conclusion: The surgical treatment of SICH has obvious positive effect and good prognosis. The overall improvement rate of conservative treatment is relatively low with a risk of aggravation.

Key words: Spinal intramedullary cavernous hemangioma, Surgical treatment, Conservative treatment, European myelopathy score

CLC Number: 

  • R651.2

Figure 1

Typical image of cavernous hemangioma of thoracic spinal cord Preoperative magnetic resonance imaging of patient No.15. The patient is female with chronic onset symptoms, her symptoms include sensory disturbances and decreased muscle strength. A, B, C, magnetic resonance imaging showed that the lesion was located in the thoracic spinal canal, with high signal intensity on T1WI and mixed signal intensity on T2WI, enhanced magnetic resonance imaging showed that the lesions could be enhanced by enhanced scanning; D, E, F, the typical signs of "black ring". Arrows showed the spinal intramedullary cavernous hemangioma lesion before surgery."

Figure 2

Typical image of intramedullary cavernous hemangioma of cervical spinal cord Preoperative magnetic resonance imaging of patient No.29. The patient is male with chronic onset symptoms, his symptoms were mainly mild sensory disturbances. A, B, lesions showed equal signals on T1WI and mixed signals on T2WI; C, lesion can be enhanced; D, E, typical signs of black rings can be seen. Arrows showed the spinal intramedullary caver-nous hemangioma lesion before surgery."

Figure 3

Comparison of magnetic resonance imaging before and after surgery for spinal intramedulary cavernous hemangioma A, preoperative magnetic resonance imaging of patient No.8. The patient is male with chronic onset symptoms, his symptoms include sensory disturbances, pain, and dysdefecation. Compared with the preoperative image, the lesion has been removed, and intramedullary mixed signal or high signal can be seen on T2WI; B, postoperative magnetic resonance imaging images of patient No.8. Arrow showed the spinal intramedullary cavernous hemangioma lesion before surgery."

Figure 4

Microsurgical resection steps of spinal intramedulary cavernous hemangioma A, incision of dura mater; B, pull dura mater to both sides; C, expose the tumor; D, burn the tumor to inactivate it and extract the tumor; E, tumor was totally extracted; F, close the dura mater."

Figure 5

Pathological results of spinal intramedulary cavernous hemangioma after surgery A, under microscope, the vessel tube was composed of fibroblasts, and the lumen was lined with thin endothelial cells, lacking elastic fibers and muscle layers (HE ×100); B, there are many fibers between the lumens, no normal spinal cord tissue was found, a patch of hemorrhages can be seen under microscope (HE ×100)."

Table 1

General information of spinal intramedulary cavernous hemangioma patients"

No.GenderAge/yearsClinical presentationChronic/acuteLocationDiameter/mmTreatmentImproved/not improved
1Male50Downregulated strength of muscle, painChronicT77SurgeryImproved
2Male51Sensory disorder, painChronicC7-T113SurgeryNot Improved
3Female32Sensory disorder, painChronicL59SurgeryNot Improved
4Female45Sensory disorder, painChronicC6-713SurgeryImproved
5Male79Downregulated strength of muscleChronicT6-715SurgeryNot Improved
6Female30Sensory disorder, pain, downregulated strength of muscleChronicC27SurgeryImproved
7Male40Sensory disorder, downregulated strength of muscle,
defecation dysfunction		ChronicT35SurgeryImproved
8Male46Sensory disorder, pain, defecation dysfunctionChronicT118SurgeryImproved
9Male65Sensory disorder, pain, downregulated strength of muscle,
defecation dysfunction		AcuteC37SurgeryImproved
10Male37Sensory disorder, pain, downregulated strength of muscle,
defecation dysfunction		AcuteT9-1012SurgeryImproved
11Female40Sensory disorder, painChronicC6-T128SurgeryNot Improved
12Female55Sensory disorder, painChronicC26SurgeryImproved
13Female49Sensory disorder, pain, downregulated strength of muscle,
defecation dysfunction		AcuteT99SurgeryImproved
14Male34Sensory disorder, pain, downregulated strength of muscle, ChronicT37SurgeryImproved
15Female55Sensory disorder, downregulated strength of muscleChronicT8-911SurgeryImproved
16Female72Sensory disorderChronicT2-315SurgeryNot Improved
17Male81Sensory disorder, downregulated strength of muscleChronicT2-317SurgeryImproved
18Male52Sensory disorder, downregulated strength of muscle,
defecation dysfunction		ChronicT48SurgeryImproved
19Female18Sensory disorder, pain, downregulated strength of muscle,
defecation dysfunction		AcuteT47SurgeryImproved
20Male36Sensory disorder, pain, downregulated strength of muscle,
defecation dysfunction		AcuteT8-912ConservativeNot Improved
21Female50PainChronicC5-613ConservativeNot Improved
22Female43Sensory disorder, downregulated strength of muscleChronicC6-711ConservativeNot Improved
23Female31Sensory disorder, painChronicC77ConservativeNot Improved
24Female48Sensory disorder, painChronicL26ConservativeNot Improved
25Male31Sensory disorderChronicT1-324ConservativeNot Improved
26Female61Downregulated strength of muscleChronicC2-423ConservativeNot Improved
27Male58Sensory disorder, pain, downregulated strength of muscleChronicT11-1211ConservativeImproved
28Female52Sensory disorder, downregulated strength of muscleChronicC5-610ConservativeNot Improved
29Male47Sensory disorder, downregulated strength of muscleChronicC4-525ConservativeNot Improved
30Female54Sensory disorder, downregulated strength of muscleChronicC3-417ConservativeNot Improved
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