Objective Intramedullary hemorrhage (IH) associated with cavernous malformation (CM) of the high cervical spine remains a significant challenge for neurosurgeons. This study aimed to evaluate the efficacy and safety of the posterolateral sulcus (PLS) approach in managing these complex cases.
Methods This single-center retrospective study included 58 cases of spinal intramedullary tumors treated surgically over the past 4 years. The PLS approach on the side of the IH was applied for the removal of CM. Neurological function was assessed using the modified McCormick functional scale (MMCS) before surgery, one week after surgery, and at the most recent follow-up.
Results Six patients with IH associated with CM above the C3 level were identified from the database. The mean age was 31.2 years, and 4 of the 6 patients were female. Symptom duration prior to surgery ranged from 0 to 48 months. Total removal of the CM was achieved in all 6 cases without any serious adverse events including respiratory complications. The average follow-up duration was 21.7 months. The mean MMCS score was 3.0 before surgery, maintained at 2.5 in the early postoperative period, and improved further to 2.2 at the most recent follow-up. One patient of ventral-type CM experienced recurrent hemorrhage at the same level 30 months after the initial surgery. This patient subsequently underwent a second surgery using the anterolateral sulcus approach, which was well tolerated.
Conclusion The PLS approach enables safe removal of CM even in the high cervical spine. However, ventral-type CMs remain a major surgical concern.
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The Role of Indocyanine Green Videoangiography in Intramedullary Spinal Cord Tumor Surgery: Focus on Lesion Localization Accuracy Jungbo SIM, Chang-Hyun LEE, Ayoung YOO, Yunhee CHOI, Woojin KIM, Hosung MYEONG, Hangeul PARK, Jun-Hoe KIM, Chi Heon KIM, Chun Kee CHUNG Neurologia medico-chirurgica.2026;[Epub] CrossRef
Objective Spinal cord cavernous malformation (CM) is an intramedullary vascular lesion that may present with progressive symptoms. Surgery is recommended for symptomatic patients, but optimal timing of surgery is debatable. Some advocate waiting until plateau of neurological recovery and others support emergency surgery. There is no statistic on how commonly these strategies are utilized. We aimed to find contemporary practice pattern among neurosurgical spine centers in Japan.
Methods A database of intramedullary spinal cord tumors assembled by Neurospinal Society of Japan was surveyed and 160 patients with spinal cord CM were identified. Neurological function, disease duration, and number of days between presentation to hospitals and surgery were analyzed.
Results Duration of disease before presentation to hospitals ranged from 0 to 336 months (median, 4 months). Number of days between patients’ presentation and surgery ranged from 0 to 6,011 days (median, 32 days). Time from symptom onset to surgery ranged from 0 to 336.9 months (median, 6.6 months). Patients with severe preoperative neurological dysfunction had shorter duration of disease, fewer days between presentation and surgery, and shorter time between symptom onset and surgery. Patients with paraplegia or quadriplegia were more likely to improve when operated on within 3 months from onset.
Conclusion Timing of surgery for spinal cord CM in Japanese neurosurgical spine centers generally was early, with 50% of patients undergoing surgery within 32 days after presentation. Further study is needed to clarify optimal timing of surgery.
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Spontaneous Regression of De Novo Cavernous Malformation in the Spinal Canal after Hemorrhage: A Case Report Minami Saura, Kiyoyuki Yanaka, Kuniyuki Onuma, Kazuhiro Nakamura, Nobuyuki Takahashi, Aiki Marushima, Eiichi Ishikawa Asian Journal of Neurosurgery.2026; 21(01): 153. CrossRef
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Objective To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs.
Methods The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts.
Results Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas.
Conclusion A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.
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Neurospine 2022;19(2):441-452. Published online June 30, 2022
Objective We performed a retrospective observational study to demonstrate the surgical risks and long-term prognoses of intramedullary tumors in Japan using a multicenter registry authorized by the Neurospinal Society of Japan.
Methods Data from 1,033 consecutive patients with intramedullary tumors, treated between 2009 and 2020, were collected from 58 centers. Patients with spinal lipomas or myxopapillary ependymomas were excluded. Patient characteristics, clinical presentations, imaging characteristics, treatments, and outcomes were analyzed. The modified McCormick scale was used to classify functional status. Survival was described using Kaplan-Meier curves, and multivariable logistic regression analyses were performed.
Results The mean age of the patients was 48.4 years. Data of 361 ependymomas, 196 hemangioblastomas, 168 astrocytic tumors, 160 cavernous malformations, and the remaining 126 cases including subependymomas, metastases, schwannomas, capillary hemangiomas, and intravascular B-cell lymphomas were analyzed. Twenty-two patients were undiagnosed. The mean follow-up duration was 46.1 ± 38.5 months. Gross total tumor removal was achieved in 672 tumors (65.1%). On the modified McCormick scale, 234 patients (22.7%) had worse postoperative grades at the time of discharge. However, neurological status gradually improved. At 6 months postoperatively, 251 (27.5%), 500 (54.9%), and 160 patients (17.6%) had improved, unchanged, and worsened grades, respectively. Preoperative functional status, gross total tumor removal, and histopathological type were significantly associated with mortality and functional outcomes.
Conclusion Our findings demonstrate better postoperative functional outcomes in patients with fewer preoperative neurological deficits. Degree of resection, postoperative treatments, and prognoses are closely related to the histology of intramedullary tumors.
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Postoperative cervical deformity sometimes occurs in the short or long term after primary surgery for cervical disorders related to the degenerative aging spine, neoplastic etiologies, hemodialysis, infection, inflammation, trauma, etc. Cervical kyphosis after posterior decompression surgery, such as laminectomy or laminoplasty, is a common problem for spine surgeons. However, revision surgery for cervical deformity is definitely one of the most challenging areas for spine surgeons. There is no doubt that surgery for cervical deformity carries a high risk of surgery-related complications that might result in aggravation of healthrelated quality of life. Revision surgery is even more challenging. Hence, spine surgeons need to assess carefully the overall severity of the underlying condition before revision surgery, and try to refine the surgical strategy to secure safe surgery. Needless to say, spine surgeons are now facing great challenges in making spine surgery a much more reliable and convincing entity.
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