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
Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larissa, Thessaly, Greece. Electronic address: firstname.lastname@example.org. Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China. Department of Surgery, Faculty of Medicine, Atma Jaya Catholic University of Medicine, Jakarta, Indonesia. Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany.
AIMS: To examine the conservative treatment of symptomatic spinal cavernomas as well as to evaluate the efficacy and safety of surgical management of SCCMs. METHODS This 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 neurological improvement or deterioration after discharge and the need for re-intervention after subtotal surgical resection or hemorrhage. RESULTS After 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 Re-intervention the final results demonstrated no potential significant difference between the two groups. As regards the subgroup of patients with Bleeding, Improvement, and Pain the results of the analysis showed a statistically significant difference between the two groups. CONCLUSIONS Patients who have experienced a hemorrhagic episode should consider surgical intervention which decreases the risk of recurrent hemorrhage and further neurological deterioration. In addition, surgical decompression obtained by resection of the hemorrhage and cavernoma seems to lead to slight neurological improvement in some patients. In non-hemorrhagic cavernomas, conservative treatment might be optimal due to surgery-related morbidity risks.