Angiomas of the spinal cord: review of the pathogenesis, clinical features, and results of surgery.

Twenty-four patients with angiomas of the thoraco-lumbo-sacral region of the spinal cord, which characteristically occur in elderly men and are situated on the dorsum of the cord, were subjected to surgery after diagnosis by selective arteriography. It is suggested that in this variety of angioma the operation produced its effect by eliminating the raised pressure in the venous and capillary vessels within the spinal cord. There was no evidence of an arterial "steal." In all cases, followed up for a mean of five years, progression of neurological symptoms was arrested but, apart from motor disability and pain, any improvement among this already seriously disabled group was small. Diagnosis in the early stages is difficult but the history of mechanical factors exacerbating the symptoms and which occur in the majority of patients should suggest the presence of such a lesion and indicate the need for myelography. Any improvement in results can only come from greater awareness of the condition leading to earlier diagnosis and operation.