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Spinal Cavernous and Capillary Hemangiomas in Adults

Babu, Ranjith MS*; Owens, Timothy R. MD*; Karikari, Isaac O. MD*; Moreno, Jessica RN, BSN*; Cummings, Thomas J. MD; Gottfried, Oren N. MD*; Bagley, Carlos A. MD*

doi: 10.1097/BRS.0b013e318287fef7
Surgery

Study Design. Retrospective cohort analysis.

Objective. To evaluate the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas.

Summary of Background Data. Spinal hemangiomas most commonly arise in the vertebral bodies and are typically asymptomatic. Uncommonly, hemangiomas may cause significant neurological deficits via extraosseous extension. Intramedullary hemangiomas may also occur and account for approximately 5% of all spinal cord lesions, with those located intradural extramedullary occurring rarely. Although retrospective studies have primarily examined the neurological outcome of intramedullary and vertebral hemangiomas, there is little literature comparing outcomes after surgical treatment of hemangiomas of varying location.

Methods. We performed a retrospective review of all patients treated for hemangiomas affecting the spinal cord at our institution between 1999 and 2012. Various patient, clinical, and tumor data were collected including patient demographics, neurological examinations, and procedure, clinic, and pathology notes. Imaging studies were evaluated to determine the extent of resection, presence of recurrence, and lesion volume. Functional status was defined using the Modified McCormick Scale (MMS).

Results. A total of 19 patients were evaluated, with our cohort consisting of 8 intramedullary, 5 intradural extramedullary, and 6 vertebral hemangiomas with extraosseous extension. Cavernous hemangiomas were most common (47.4%), followed by those of the capillary type. At long-term follow-up, 73.7% of patients had improved neurological outcome and 15.8% had worsened. However, only 50% of patients with intramedullary hemangiomas improved, compared with 80% and 100% for intradural extramedullary and vertebral hemangiomas, respectively. Also, those with intramedullary lesions more frequently had worse outcomes after surgery (25%) than those with intradural extramedullary (20%) and vertebral hemangiomas (0%).

Conclusion. Although all patients typically present with a similar functional status, patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with intradural extramedullary and vertebral hemangiomas.

Level of Evidence: 4

In this study, we evaluated the neurological outcomes after resection of intramedullary, intradural extramedullary, and extradural hemangiomas. Patients with intramedullary lesions are more unlikely to improve after surgical resection and derive less of a benefit compared with those with extramedullary and vertebral lesions.

*Division of Neurosurgery, Department of Surgery, and

Department of Pathology, Duke University Medical Center, Durham, NC.

Address correspondence and reprint requests to Carlos A. Bagley, MD, Division of Neurosurgery, PO Box 3087, Duke University Medical Center, Durham, NC 27710; E-mail: carlos.bagley@duke.edu

Acknowledgment date: July 20, 2012. First revision date: December 19, 2012. Acceptance date: January 12, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consulting fee or honorarium.

© 2013 Lippincott Williams & Wilkins, Inc.