Cervical Intramedullary Cavernous Angioma : A Report of 3 Surgical Case

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The detection rate of spinal intramedullary cavernous angioma (IMCA) has increased with the increasing use of magnetic resonance imaging (MRI) techniques. The risk of progressive deterioration after serial hemorrhagic events is well recognized, but the indications for surgical resection of spinal IMCA are controversial. We present three consecutive cases of surgically treated cervical IMCA. Two patients had obvious signs of sensorimotor deficit corresponding to the level of the lesion. The other patient presented with frequent episodes of dizziness and neck pain. T2-weighted MRI showed characteristic hemosiderin deposits in all 3 cases. The cervical IMCAs in this series were located on the dorsal surface of the spinal cord. Areas of discoloration (hemosiderin deposits) were easily identified on the surface of the spinal cord in all three cases, glial planes were identified between the lesions and spinal cord. Total resection of the IMCAs was achieved by careful microsurgical dissection under intra-operative monitoring. The Valsalva maneuver was used to check for residual vascular lesions. When dorsal cervical IMCAs are identified by MRI, surgical treatment should be considered to prevent catastrophic deterioration due to recurrent hemorrhage.
日本脊髄外科学会の論文