PINEHURST — When a recent patient arrived at the emergency department with a loss of sensation and severe weakness in their legs, it marked the start of a journey to advanced care that highlights the expertise of FirstHealth Neurosurgery & Spine.
The patient’s MRI revealed the cause of the symptoms, a cavernous malformation with a hematoma within the spinal cord. Cavernous malformations are abnormal clusters of small blood vessels that create wide “caverns” of slow-flowing blood that can lead to significant neurological symptoms.
The patient was referred to Board Certified Neurosurgeon James Walker, M.D., of FirstHealth Neurosurgery & Spine in Pinehurst, for evaluation and treatment.
According to Dr. Walker, individuals diagnosed with cavernous malformation usually undergo extensive spinal surgery to remove the lesion from the spinal cord.
“Given the location of the cavernous malformation, traditional open surgery was deemed to be problematic and higher risk,” said Dr. Walker. “We opted for a minimally invasive approach using a small incision that was approximately one inch.”
Dr. Walker performed the surgery at Moore Regional Hospital in Pinehurst and was able to remove the cavernous malformation and the associated hematoma, using a small tubular retractor with high-power magnification and use of an operative microscope.
“Minimally invasive surgeries for resection of spinal cord lesions have rarely been performed,” added Dr. Walker. “But this approach allowed us to mitigate risks of prolonged postoperative pain and potential blood loss and help the patient recover more quickly.”
Other advantages of the minimally invasive approach are less risk of complications such as infection, complications from spinal fluid leaks or complications related to an inability to walk due to postoperative pain.
This groundbreaking procedure performed for the first time by Dr. Walker at Moore Regional Hospital in Pinehurst gained international recognition, as it was published in the Surgical Neurology International journal in August 2024. The case was confirmed as the first-ever described minimally invasive approach for treating such a lesion worldwide.
Following the surgery, the patient experienced significant improvement in strength and sensation in their lower extremities.
Cavernous malformations, which are also referred to as cavernomas or cavernous angiomas, are found in 0.1% of the population and have a higher occurrence in the Hispanic population due to genetic factors. Approximately 20% of cavernous malformations are hereditary. They are an abnormal bundle of blood vessels in the spine or brain that have a propensity to bleed over time causing irritation to the surrounding neural tissue.
According to Dr. Walker, they often present as seizures when located within the brain, but with spinal cavernous malformations, they present with weakness and numbness.
“Most cavernomas can be observed and are asymptomatic,” added Dr. Walker.
Dr. Walker recommends that individuals consult with their primary care provider if they have a family member who has had a cavernous malformation as they could benefit from screening.
The neurosurgery team at FirstHealth Neurosurgery & Spine in Pinehurst specializes in the neurological treatment of diseases and disorders of the brain, spine and peripheral nerves. The office is in Pinehurst at 10 Aviemore Drive. For more information about FirstHealth Neurosurgery & Spine, call 910-715-8700 or 855-535-8700.
