Surgical Approaches to Intramedullary Cavernous Malformations of the Spinal Cord

BACKGROUND: Resection of intramedullary spinal cord cavernous malformations is associated with a significant risk of morbidity because of the high density of eloquent tissue within the spinal cord. Despite this risk, surgery remains the definitive treatment for symptomatic lesions. OBJECTIVE: To review the clinical aspects of surgical approaches for spinal cord cavernous malformations. METHODS: This article reviews the epidemiology, pathophysiology, clinical and imaging characteristics, and indications for surgical resection. Surgical issues and operative approaches by anatomical location are also detailed, drawing from evidence in the literature and from the senior author's clinical experience. RESULTS: The 3 primary approaches to spinal cord cavernous malformations-the posterior, posterolateral, and lateral approaches-are described and illustrated. Magnetic resonance imaging and intraoperative photographs of representative cases are included. CONCLUSION: Intramedullary spinal cord cavernous malformations are complex entities, and it is our hope that this article will improve readers' understanding of their clinical characteristics, their indications for treatment, and the surgical pathways through which these lesions can be safely resected.