Surgical versus Conservative Management of Spinal Cord Cavernous Angiomas: A Systematic Review and Comparative Meta-Analysis

Introduction: Spinal cord cavernous angiomas (SCCAs) are rare vascular malformations. These lesions are usually treated surgically; however, due to the high density of eloquent structures in the spinal cord, significant surgical morbidity, and the recent increase in diagnosis due to better imaging technology, conservative management has emerged as a valid alternative option. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of surgical versus conservative management of SCCAs.

Methods: Our study included articles comparing outcomes following conservative and surgical management of spinal cavernomas, published in full-text form. Collected variables included the total number of patients, spine level, resection, myelotomy, and at follow-up, bleeding, motor weakness, pain, bladder dysfunction, bowel dysfunction, and neurologic improvement or deterioration after discharge. The primary outcome of interest was the long-term functional outcome.

Results: We included ten articles in the final article pool. The total number of patients was 491, with 332 (67.6%) undergoing surgical resection and 159 (32.4%) conservative management. Regarding motor weakness, bladder/bowel dysfunction, and deterioration, the final results demonstrated no significant difference between the two groups. However, the analysis showed a statistically significant difference between the two groups in bleeding and long-term functional improvement. Despite the superiority of surgery, we did not find a statistically significant difference in short-term functional outcomes between surgery and conservative treatment (OR=4.14; CI 95% [1.95 to 8.78], p=0.97). The long-term functional outcome differed significantly between the two groups, favoring the surgical treatment (OR= 2.74; CI 95% [0.89 to 8.43], p=0.01).

Conclusion : Surgical management of spinal cord cavernous angiomas is associated with better long-term functional outcomes. In addition, patients who have experienced a hemorrhagic episode should consider surgical intervention, which decreases the risk of recurrent hemorrhage and further neurologic deterioration.