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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Brainstem cavernous malformations: 1390 surgical cases from the literature
Bradley A Gross1, H Hunt Batjer, Issam A Awad
1Department of Neurological Surgery, Brigham and Womens Hospital and Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurgery
|April 10, 2012
Summary
Surgical resection of brainstem cavernous malformations (CM) is challenging, with significant morbidity. Surgery is recommended only for patients with prior hemorrhage and pial representation, emphasizing careful counseling on risks and outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Medical Research
Background:
- Brainstem cavernous malformations (CM) pose surgical challenges.
- Recent large surgical series necessitate updated reviews.
- Previous meta-analyses provide a foundation for current understanding.
Purpose of the Study:
- To review and synthesize outcomes from recent surgical series of brainstem CM.
- To compare new data with previous findings.
- To provide an updated evidence base for surgical decision-making.
Main Methods:
- A PubMed search identified 18 new surgical series (710 patients).
- Data on complete excision, complications, and outcomes were compiled.
- Results were compared and combined with a prior meta-analysis.
Main Results:
- Analysis of 68 series (1390 patients) showed 91% complete excision.
- 62% of partially resected CMs rebled; 45% experienced early neurologic morbidity.
- 1.5% overall mortality; 84% had improved or stable long-term outcomes.
Conclusions:
- Brainstem CM resection remains challenging with significant morbidity.
- Surgery is advised for patients with prior hemorrhage and pial CM representation.
- Crucial to counsel patients on early morbidity and potential long-term worsening.
