Related Experiment Videos
Surgical management of hematomas of the brain stem
A N Konovalov1, A Spallone, U B Makhmudov
1Institute of Neurosurgery "N.N. Burdenko," Academy of Medical Sciences of USSR, Moscow.
Insights
Surgery is the recommended treatment for brain-stem hematoma. This approach successfully treated nine patients, with most experiencing a full recovery and no symptom recurrence after removing the hematoma and any underlying cryptic arteriovenous malformations.
Area of Science:
- Neurosurgery
- Neurology
- Neuroradiology
Background:
- Brain-stem hematomas often present with symptoms mimicking intra-axial tumors.
- Diagnosis can be challenging, with angiography frequently being noncontributory.
Observation:
- Computerized tomography (CT) revealed diverse lesion characteristics, but no clear correlation with clinical duration.
- Magnetic resonance imaging (MRI) confirmed brain-stem masses but did not directly identify vascular malformations.
- Surgical intervention allowed for lesion removal and biopsy, revealing cryptic arteriovenous malformations in most cases.
Findings:
- Six of nine patients with brain-stem hematoma were found to have underlying cryptic arteriovenous malformations.
- Surgical total removal of the hematoma was effective in all treated patients.
- Three patients experienced minor, transient complications post-surgery.
Implications:
- Surgery is the treatment of choice for brain-stem hematoma.
- Early surgical intervention may lead to favorable outcomes and prevent symptom recurrence.
- Identifying and treating associated vascular malformations is crucial for successful management.
Abstract:
Nine patients with brain-stem hematoma were admitted to the authors' institute during the period from 1985 to 1988. Clinical symptoms and signs pointed to pontine involvement in most cases. Progressive clinical deterioration was quite common and usually led to a clinical diagnosis of brain-stem intra-axial tumor. Angiography was noncontributory; computerized tomography (CT) was the main diagnostic test. This gave evidence of different pathological characteristics, including masses showing highly increased density, nonhomogeneous hyperdense lesions, and isodense lesions with peripheral contrast enhancement. No clear correlation was found, however, between the presumed duration of the clinical picture and the CT characteristics of the lesion. In the last four cases, magnetic resonance imaging was performed using a 0.015-tesla resistive system. This examination usually confirmed the presence of a brain-stem mass already shown by previous CT scans. There were, however, no cases in which direct evidence of an intra-axial vascular malformation could be obtained. The patients were all treated surgically with an attempt at total removal of the lesion and thorough inspection of the hematoma cavity and biopsy. Evidence of "cryptic" arteriovenous malformation was obtained in six of the nine cases. There were minor transitory complications in three cases. All of the patients were able to resume their previous activity, and none suffered recurrence of the symptoms following the operation. It may be concluded that surgery is the treatment of choice for brain-stem hematoma.