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Cavernous malformations of the brainstem: experience with 100 patients
R W Porter1, P W Detwiler, R F Spetzler
1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona 85013-4496, USA.
Journal of Neurosurgery
|July 21, 1999
Summary
Cavernous malformations of the brainstem (CMBs) have a worse natural history than those in other locations. Surgical resection via skull base approaches is a viable option for symptomatic CMBs, with associated venous anomalies requiring preservation.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Cavernous malformations of the brainstem (CMBs) represent a significant neurosurgical challenge.
- Understanding their natural history and surgical outcomes is crucial for patient management.
Purpose of the Study:
- To review surgical experience with brainstem cavernous malformations.
- To clarify the natural history, indications, and surgical risks of CMBs.
Main Methods:
- Retrospective review of 100 patients with 103 CMBs treated between 1984 and 1997.
- Evaluation of clinical data, imaging, pathology, and operative reports.
- Analysis of surgical outcomes, including morbidity, mortality, and functional status.
Main Results:
- The annual hemorrhage rate for CMBs was estimated at 5% per lesion.
- 86 patients underwent surgical resection using skull base approaches.
- Post-surgery, 87% of patients were stable or improved, with 12% experiencing permanent morbidity.
Conclusions:
- CMBs exhibit a more aggressive natural history compared to cavernous malformations in other brain regions.
- Skull base surgery is indicated for symptomatic CMBs, particularly those near the pial surface.
- Associated venous anomalies are consistently present and must be preserved during surgery.