• World Neurosurg · Aug 2021

    Review Meta Analysis

    The outcome in patients with spinal cavernomas presenting with symptoms due to mass effect and/or hemorrhage: conservative vs surgical management. A meta-analysis: Direct Comparison of Approach-Related Complications.

    • George Fotakopoulos, Juri Kivelev, Hugo Andrade-Barazarte, Mardjono Tjahjadi, Felix Goehre, and Juha Hernesniemi.
    • Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, Thessaly, Greece. Electronic address: gfotakop@yahoo.gr.
    • World Neurosurg. 2021 Aug 1; 152: 6-18.

    ObjectiveWe sought to examine the conservative treatment of symptomatic spinal cavernomas and evaluate the efficacy and safety of surgical management of spinal cord cavernous malformations.MethodsThis meta-analysis included articles comparing outcomes of conservative treatment and surgical management of spinal cavernomas, published in the full-text form (from 2000 to June 31, 2020). Collected variables included first author name, country, covered study period, publication year, the total number of patients and at follow-up, bleeding, motor weakness, pain, bladder and/or bowel dysfunction neurologic improvement or deterioration after discharge, and the need for reintervention after subtotal surgical resection or hemorrhage.ResultsAfter the initial searching and applying all exclusion and inclusion criteria, there were 9 articles left in the final article pool. The total number of patients was 396 with 264 (66.6%) undergoing surgical resection and 132 (33.4%) electing conservative management. Regarding motor weakness, bladder/bowel dysfunction, deterioration, and reintervention, the final results demonstrated no potential significant difference between the 2 groups. In regard to the subgroup of patients with bleeding, improvement, and pain, the results of the analysis showed a statistically significant difference between the 2 groups.ConclusionsPatients who have experienced a hemorrhagic episode should consider surgical intervention, which decreases the risk of recurrent hemorrhage and further neurologic deterioration. In addition, surgical decompression obtained by resection of the hemorrhage and cavernoma seems to lead to slight neurologic improvement in some patients. In nonhemorrhagic cavernomas, conservative treatment might be optimal due to surgery-related morbidity risks.Copyright © 2021 Elsevier Inc. All rights reserved.

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