Spinal cavernous hemangiomas (SCA) 1. Overview: SCA, also known as spinal cavernous vascular malformation, is currently considered to be one of the occult spinal vascular malformations, accounting for 3% to 16% of all spinal vascular malformations. The majority of middle-aged people. It can occur in different parts of the spinal cord, the thoracic segment is common, single or multiple, often combined with intracranial CA. The application of MRI has gradually increased its detection rate, a significant proportion of patients are asymptomatic, symptomatic patients are mostly middle-aged, the average duration of the disease 2-3.5 years. 2. Clinical symptoms: Recurrent back or limb pain is common, and there may be sensory and motor impairment. Chronic neurological impairment is mostly sensory dysfunction and sphincter dysfunction. Acute spinal cord dysfunction is mostly due to SCA hemorrhage. There are four types of clinical symptoms: (1) due to repeated microscopic hemorrhage or aberrant vascular thrombosis. Intermittent, recurrent episodes of neurological dysfunction occur and get progressively worse, but there is varying degrees of recovery of neurological function between episodes. (2) Due to progressive enlargement of cavernous hemangioma. Chronic progressive neurological decompensation occurs. (3) Rapid onset and rapid neurological decompensation due to spinal cord parenchymal hemorrhage, after which some patients can recover relatively quickly. (1) MRI: It is the main diagnostic tool for the diagnosis of SCA because of its specificity and the dilated sinus and slow blood flow, which can easily cause thrombosis; the thin sinus wall, which can easily rupture and bleed; the new and old bleeding foci formed after repeated bleeding and the iron-containing heme deposits and calcification are the pathological basis of MRI: the thrombus and repeated bleeding in the center of the hemangioma show high signal, while the surrounding iron-containing heme ring shows low signal. rings are low signal. Similar to intracerebral cavernous hemangioma, MRI of typical SCA shows a mixed signal shadow on T1-weighted image and a high signal shadow on T2-weighted image, surrounded by a low signal ring, typically with a “bull’s eye” sign. The center of the lesion may be uniformly and slightly enhanced. There is usually no vascular flow, which can be distinguished from vascular malformations. For surgical purposes, T2-weighted images provide a more realistic picture of the size and location of the lesion. In the hemorrhagic phase, the MRI performance is complicated: T1 and T2 high signal can be demonstrated in the acute phase, and the signal intensity gradually decreases in the subacute phase due to the transformation of deoxyhemoglobin to orthohemoglobin. (2) DSA: Since SCA is an occult vascular disease, DSA generally has no obvious abnormalities. (3) According to the location of SCA in the spinal cord, it can be divided into the following four types Type l: intramedullary type, the most common, more than 90%; Type II: intradural extramedullary type; Type III: epidural type, the least common; Type IV: vertebral body type, more common, can invade to the epidural. 4, treatment: (1) asymptomatic, can be followed up. (2) Those with symptoms are indications for surgical removal of the lesion. Surgery: According to MRI positioning combined with preoperative spinal X-ray positioning markers, open the corresponding vertebral plate. The dura mater is incised and a yellowish, bluish-purple or purplish-brown area with iron-containing heme deposits on the surface of the spinal cord is visible; the surface of the intramedullary spinal cord may be normal. Under the surgical microscope, the spinal cord is incised longitudinally in a more localized area of fullness; in the absence of these features, the incision should be made in the middle of the spinal cord, requiring avoidance of the posterior spinal veins. The hemangioma is seen to be mulberry or lobulated and is usually well defined. The hemangioma is carefully dissected along the border under the microscope and excised in pieces or in its entirety. (See Figure 3-9-23.) Intraoperative bleeding can usually be controlled by weak electrocoagulation. Intravenous bleeding can be stopped by compression with gelatin sponges and hemostatic gauze. If bleeding continues uncontrolled. Further exploration for residual cavernous hemangioma should be performed. Brotchi (2002) advocated that the whole lesion should be removed along the relative boundaries of the periphery of the hemangioma, but not in pieces to avoid aggravation of bleeding and thermal coagulation injury, and the combined hematoma should be removed first and decompressed as soon as possible. In the case of multiple SCAs, only the symptomatic lesions should be surgically removed, and the remaining ones should be followed up; if the multiple lesions are not far apart from each other, they can be removed together without aggravating the functional damage of the spinal cord, especially the non-symptomatic lesions downstream of the symptomatic lesions. (3) Timing of surgery: Intramedullary SCA can deteriorate rapidly due to acute bleeding because of its narrow compensatory space. Therefore, radical resection of the lesion should be performed when symptoms appear, and the surgery should be performed more actively for recurrent patients. The timing of surgery should generally be early before rebleeding or tumor enlargement. In acute cases, surgery should be performed as a matter of urgency. Do not delay surgery due to temporary relief of symptoms, which may lead to rebleeding and affect the efficacy. (4) Efficacy and prognosis: Removal of the lesion before the spinal cord is severely damaged can lead to good treatment results; if the spinal cord is severely damaged, even if the lesion is removed, it is difficult to restore the function of the spinal cord.