Prognostic factors for spinal cord cavernous hemangioma resection and optimal surgical timing for symptomatic patients.

Abstract

Spinal cord cavernous hemangioma (CH) is a rare intramedullary vascular lesion with a risk of hemorrhage and progressive neurological deterioration. While resection is the standard treatment for symptomatic CH, the optimal timing for surgery remains uncertain. This study aimed to examine surgical outcomes, find prognostic factors of functional independence, and suggest the optimal surgical timing in functionally dependent patients. A retrospective analysis was conducted on the medical records of 40 patients who underwent resection for CH at a tertiary medical institution between January 2002 and December 2023. The modified McCormick (MMC) scale was used, and the scores were defined as follows: MMC scores 1 and 2 indicated functional independence, and MMC scores 3-5 indicated functional dependence. The clinical outcomes of all patients were analyzed, and factors associated with functional independence at the last follow-up were identified. Additionally, in the initially functionally dependent group, the optimal surgical timing was determined by identifying the symptom duration that maximized the number of patients achieving MMC score improvement. The mean follow-up duration was 48.4 ± 46.8 months (range 7.2-208.6 months). At the last follow-up, 62.5% of patients were functionally independent, and 18 patients showed improvement in their MMC score. Initial functional independence was the strongest factor (OR 8.41, 95% CI 1.73-40.86; p = 0.008), followed by location of CH at the cervical level (OR 5.42, 95% CI 1.01-29.23; p = 0.049). The functionally dependent group had a significantly shorter surgical time since symptom onset (0.4 vs 8.8 months, p = 0.002). An optimal surgical timing threshold of 8.2 months was identified for functionally dependent patients (p = 0.002). Initial functional independence and cervical lesion location were key predictors of postoperative functional independence at the last follow-up. Among patients with initial functional dependence, surgical treatment within 8.2 months was identified as optimal timing. Larger studies are needed to refine patient selection and surgical timing for CH.