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Surgical management of cavernous malformations of the brain stem
I M Ziyal1, L N Sekhar, E Salas
1Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA.
Insights
Surgical removal of brain stem cavernous malformations is effective, with excellent outcomes in most patients. Complete excision is recommended for symptomatic or bleeding lesions, avoiding radiosurgery.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Brain stem cavernous malformations are rare vascular anomalies.
- These lesions often present with hemorrhage, neurological deficits, or seizures.
- Surgical management remains a challenge due to the delicate anatomy of the brain stem.
Purpose of the Study:
- To evaluate the efficacy and safety of different surgical approaches for brain stem cavernous malformations.
- To determine optimal surgical strategies and outcomes for these lesions.
- To compare surgical resection with other treatment modalities.
Main Methods:
- Retrospective analysis of nine patients with brain stem cavernous malformations.
- Surgical excision using six different skull base approaches.
- Neurological assessment and magnetic resonance imaging (MRI) for evaluation.
- Mean follow-up period of 49 months.
Main Results:
- Total removal achieved in seven patients with no recurrence.
- One patient with medullary cavernoma had recurrence without further growth.
- One patient with pontomesencephalic malformation and partial resection experienced rebleeding.
- Excellent or good surgical results in eight out of nine patients.
Conclusions:
- Surgical resection is recommended for symptomatic, bleeding, or growing brain stem cavernous malformations.
- Skull base approaches provide effective access for complete excision.
- Radiosurgery is not recommended for these lesions.
Abstract:
Different surgical approaches to the brain stem with results of excision of brain stem cavernous malformations are reported. Nine patients with brain stem cavernous malformations were operated with six different approaches. The patients were evaluated neurologically, and by magnetic resonance imaging (MRI) examination. All patients had at least one and often more episodes of haemorrhage. Seven patients underwent the total removal of the malformation, without recurrence. One patient with a large medullary cavernoma had recurrence, but without further growth. One patient with a large pontomesencephalic malformation and partial resection, suffered rebleeding due to residual cavernoma. The mean follow-up period was 49 months (range 3-112). The results of surgery were excellent or good in eight patients, and poor (worsening) in one. It is concluded that surgical resection is recommended for the cavernous malformations of the brain stem which are symptomatic, have bled or are growing, and are approachable through one of the pial surfaces of the brain stem. Different skull base approaches are useful for this procedure. Radiosurgery is not recommended in such cases.