Introduction: No study of intramedullary cavernous hemangioma of the spinal cord has evaluated the surgical results and spinal cord monitoring findings in patients who had motor paresis that was recovered before surgery. The objective was to investigate the clinical course of motor paresis and ambulatory ability before and after surgery, to evaluate how preoperative spontaneous recovery impact on the intraoperative monitoring findings and the extent of tumor resection.
Methods: The subjects were 44 patients (20 male and 22 female, average age of 38 years) with intramedullary cavernous hemangioma of the spinal cord who underwent surgery. The mean follow-up period was 10 years. The preoperative motor paresis, the pre- and postoperative course of motor paresis, the extent of tumor resection, pre- and postoperative ambulatory ability, intraoperative spinal cord monitoring findings and the recurrent tumor were evaluated.
Results: An acute motor paresis at onset was found in 22 patients (50%). All 22 of these patients recovered from the motor paresis immediately before surgery; however, the amplitude of intraoperative spinal cord monitoring decreased easily in spite of spontaneous recovery from paresis before surgery. Total resection was completed in 40 patients and subtotal and partial resection in 2 respectively. However, 2 patients that underwent partial resection developed rebleeding and worsened symptoms, and one of those patients underwent reoperation and recovered his ambulatory ability. The percent of total resection was high and postoperative stable ambulatory ability was achieved among the patients with good preoperative ambulatory ability.
Conclusions: Patients with preoperative motor paresis have severe damage to the spinal cord and require more careful spinal cord monitoring and surgical procedures for total resection, even if the patients recovered the muscle strength immediately before surgery. Patients with mild symptoms and good preoperative ambulatory ability should undergo surgery for total resection to achieve good postoperative ambulatory ability and good surgical results.
Patient Care: Our research will contribute to establish the best timing of surgery for this intramedullary spinal cord tumor without postoperative paralysis.
Learning Objectives: to investigate the clinical course of motor paresis and ambulatory ability before and after surgery, to evaluate how preoperative spontaneous recovery impact on the intraoperative monitoring findings and the extent of tumor resection.