Surgical versus conservative management of spinal cord cavernous malformations: a systematic review and comparative meta-analysis

作者：Jorge Ríos-Zermeño, Abdul Karim Ghaith, Juan P Navarro-Garcia de Llano, Victor Gabriel El-Hajj, Omar R. Ortega-Ruiz, Elena Greco, Anshit Goyal, Krishnan Ravindran, Jeyan S. Kumar, Lindsy N. Williams, Mohamad Bydon, Rabih G. Tawk · 发表于：Journal of Neurosurgery Spine · 年份：2025 · DOI：10.3171/2024.10.spine24432 · 被引用次数：5 · 研究领域：Vascular Malformations Diagnosis and Treatment、Vascular Malformations and Hemangiomas、Spinal Fractures and Fixation Techniques

OBJECTIVE: Spinal cord cavernous malformations (SCCMs) are rare vascular malformations with a capricious prognosis. Given the eloquent nature of the spinal cord, considerable surgical morbidity may be encountered. Therefore, conservative management has emerged as a valid alternative, especially for incidental lesions diagnosed on ubiquitous imaging. The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of surgical versus conservative management of SCCMs. METHODS: Following PRISMA guidelines, this study included articles published in full-text form comparing the outcomes following conservative and surgical management of SCCMs. Collected variables included the total number of patients, spine level, resection, myelotomy, follow-up duration, bleeding, motor weakness, pain, bladder and/or bowel dysfunction, and neurological improvement or deterioration after discharge. The primary outcome of interest was long-term functional outcome. RESULTS: Eleven articles comprising 515 patients were included, of whom 343 (66.6%) underwent resection and 172 (33.4%) were managed conservatively. Patients who underwent surgery were more likely to have preoperative motor deficits, hemorrhagic episodes, and bladder and/or bowel dysfunction, indicating increased disease severity. Resection was associated with significantly improved long-term functional outcomes (OR 3.27, 95% CI 1.72-6.24) compared with conservative management. There was no significant difference ...