[Surgical significance of cavernous hemangioma of the brain stem]

Cavernous hemangiomas are identified as source of brainstem hemorrhage in increasing numbers by magnetic resonance imaging. The optimal treatment of this rare vascular malformation, indication for surgery and time of intervention is still under discussion as the experience so far is mainly based on case reports. We have investigated a series of 20 patients with cavernous hemangiomas of the brainstem between 1986 and 1990, 10 of them underwent surgical removal of the lesion. Based on these experiences we conclude: Surgical removal of cavernous hemangiomas should be attempted in patients with recurrent hemorrhage, persistent or progressive neurological deficit. In cases with additional venous malformation the cavenoma should be selectively removed. Surgery should be radical, as residual cavernoma can cause recurrent bleedings. Surgery should be performed during the subacute stage. Late surgery increases the risk for additional neurological deficit. Neurophysiologic monitoring can be helpful to minimize surgical risk.