Intramedullary cavernous angioma - Resection by oblique corpectomy

BACKGROUND Intramedullary cavernomas are rare lesions usually operated on via a posterior approach and myelotomy. CASE REPORT A 42-year-old woman progressively developed a tetraplegia with sphincter disturbances over a period of 26 years. Magnetic resonance imaging showed a cervical intramedullary cavernoma with an extramedullary anterolateral exophytic portion. To avoid myelotomy, this lesion was approached directly via its anterior exophytic portion. Through a cervical anterolateral approach, the vertebral body of C4 and the intervertebral discs were obliquely drilled out. The posterior longitudinal ligament and the dura mater were opened. The exophytic portion was coagulated and the intramedullary portion was completely excised. The dura mater was closed and a bone graft was inserted between C3 and C5 and secured with a plate. RESULTS After transient worsening, upper limb weakness improved from its preoperative status but paraparesis persisted after a follow-up of 12 months. The sphincter disturbances disappeared. CONCLUSIONS The anterolateral approach combined with oblique corpectomy may be an appropriate technique in case of anterior intramedullary cavernomas. It provides direct access to the lesion, avoiding additional myelotomy. (C) 1999 by Elsevier Science Inc.