Spinal Cavernoma

Cavernous malformations of the central nervous system (CNS), particularly spinal cavernomas, are rare vascular pathologies with a prevalence of 0.4–0.6%. While MRI has significantly increased detection, evidence on the natural history and outcomes of spinal cavernomas remains limited. The mean age of presentation is 39.1 years. Clinical manifestations include a mix of motor, sensory, and autonomic deficits, and 92% of reported cases underwent surgical intervention, potentially overestimating severity. Hemorrhage rates range from 1.4% to 6.8%, with higher rates in symptomatic and about 0.8% in asymptomatic cases. Pathologically, spinal cavernomas resemble those in the brain, displaying slow-flow, non-shunting malformations. MRI is the preferred diagnostic tool, revealing characteristic “popcorn-like” mixed signals. Surgical removal is the primary curative option, demanding meticulous planning due to the spinal cord’s eloquence. Outcome studies predominantly involve surgical cases, with reported neurological recovery depending on initial presentation and timing of surgery. Pediatric cases exhibit a higher rehemorrhage rate, emphasizing the need for early intervention. In the absence of a clear role for conservative management, surgery within 3 months of symptom onset is recommended for symptomatic cases. Factors such as acute presentation, motor symptoms, and superficial lesions correlate with better surgical outcomes. Conversely, deep-seated, asymptomatic, or mildly symptomatic lesions may be safely managed conservatively. Overall, despite challenges, surgical resection remains the preferred treatment for spinal cavernomas, with nuances depending on various clinical and radiological factors.