Conus medullaris cavernous malformation

• Thoracic Intradural Extramedullary Cavernous Malformation Mimicking Meningioma
• A case of spinal cord intramedullary cavernoma
• An Alternative Approach to Surgery or Radiosurgery for Treating Cerebral Cavernous Malformations? A Case Report with Literature Review
• Treatment of Spinal Cavernous Malformations: A Single-Center Case Series
• Surgical versus conservative management of spinal cord cavernous malformations: a systematic review and comparative meta-analysis
• Automated White Matter Fiber Tract Segmentation for the Brainstem
• Utility of narrow band imaging in a patient with a spinal cord cavernous malformation
• Crossed Brainstem Syndrome of the Tectal Plate's Inferior Colliculus Revealing Quadrigeminal Midbrain Cavernous Malformation

A cavernous malformation (also known as a cavernoma) in the conus medullaris is a type of vascular abnormality that occurs in the lower end of the spinal cord.

Depending on the size and location of the cavernous malformation, symptoms can vary. Common symptoms associated with a conus medullaris cavernous malformation might include:

Back pain

Motor dysfunction or weakness in the legs

Sensory disturbances in the lower limbs

Bladder and bowel dysfunction

Sexual dysfunction

Diagnosis typically involves imaging studies such as MRI, which can provide detailed images of the spinal cord and identify vascular malformations. In some cases, CT scans or spinal angiography may also be used.

Treatment options depend on the symptoms, size, and growth of the cavernous malformation. Options might include:

Monitoring: If the cavernoma is small and not causing symptoms, regular monitoring with MRI may be recommended.

Surgery: If the cavernous malformation is symptomatic or causing significant problems, surgical intervention might be considered to remove or reduce the malformation. This is usually considered if conservative management is not effective.

The prognosis varies depending on the individual case and the effectiveness of the treatment. In some cases, symptoms may improve or stabilize with appropriate treatment.

Cavernous angioma of the cauda equina: A case report ¹⁾.

Cone cavernoma with a twice secondary intramedullary hemorrhage ²⁾.

A 28-year-old woman who presented with bilateral lower limb paraparesis following an intramedullary haemorrhage from conus medullaris CM during the peripartum period. This is the first such case. They also review a handful of other reported cases of peripartum symptomatic spinal intramedullary CMs from the literature highlighting the pathogenesis of such cases and the best timing for intervention ³⁾.

Cavernous malformation in the conus medullaris ⁴⁾.

An interesting case of conus medullaris cavernoma that was initially treated as transverse myelitis. Haemorrhagic lumbar puncture led us to perform magnetic resonance (MR) imaging, which showed the presence of a cavernous angioma at the D12-L1 level. The total excision of the lesion was followed by dramatic improvement. We suggest that MR imaging be performed early in all suspected cases of transverse myelitis so that emergency surgical intervention can be offered before the development of permanent neurological deficits ⁵⁾.

Cavernous malformations of the conus medullaris are rare lesions; only 9 cases have been reported in the literature. Most cases are described in adults and only one case has been reported in pediatric age group. In this report, the authors describe a 16-year-old male presenting with acute myelopathy due to an intramedullary cavernous malformation of the conus medullaris. The clinical, radiological and surgical features of this patient are presented and discussed and relevant literature of this rare lesion is reviewed ⁶⁾.

Montano N, Signorelli F, Tufo T, Sioletic S, Lauretti L, Pallini R, Maira G, Doglietto F. Teaching NeuroImages: extralesional bleeding of conus medullaris cavernoma. Neurology. 2010 Jul 6;75(1):e1. doi: 10.1212/WNL.0b013e3181e6209b. PMID: 20603476 ⁷⁾.

A 29-year-old Arabian man was admitted to the hospital with a progressive sensory loss to light touch, pin prick and vibration of the right and in a lesser extent of the left leg without any association to a particular dermatome. He additionally presented with progressing paresthesias in both legs, unsteady gait and incipient bladder- and bowl incontinence starting approximately 1 week prior to admission. Spinal MRI showed a central, slightly lateralized intramedullary lesion 1 cm in diameter located within the conus medullaris that was suspicious for an intramedullary cavernous malformation. The lesion was accompanied by a perifocal edema and showed an inhomogeneous hypointense core on T2WI consistent with an acute cavernous hemorrhage. Treatment of symptomatic intramedullary cavernous angiomas should, if possible, consist of total surgical excision. It is essential to achieve complete removal during the first operation to avoid any residues that may lead to further bleeding ⁸⁾.

A 74-year-old man who initially developed low back pain and numbness of the right leg and subsequently paraplegia, ASIA impairment scale 'c'. MRI revealed a cavernous angioma of the conus medullaris with perilesional oedema and signs of acute bleeding. Clinical improvement was associated with changes in the MRI ⁹⁾.