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Updated: May 8, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Published on: October 20, 2017

Surgery of brainstem cavernous malformations.

O Bradac1, M Majovsky, P de Lacy

  • 1Department of Neurosurgery, Military University Hospital, U Vojenske Nemocnice 1200, Prague, 169 02, Czech Republic, ondrej.bradac@uvn.cz.

Acta Neurochirurgica
|August 27, 2013
PubMed
Summary
This summary is machine-generated.

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Neurosurgery for brainstem cavernomas offers an 89.5% favorable outcome. While risks exist, surgical intervention is preferred for first-time bleeds due to high rebleed rates and poor outcomes with conservative management.

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Neurosurgical Oncology

Background:

  • Cerebral cavernomas are vascular malformations with a significant proportion located in the brainstem.
  • Brainstem cavernoma resection presents substantial neurosurgical challenges due to the critical location of these lesions.

Purpose of the Study:

  • To evaluate the efficacy and safety of surgical resection for brainstem and deep supratentorial cavernomas.
  • To determine the rate of favorable outcomes and operation-related morbidity and mortality in patients undergoing cavernoma surgery.

Main Methods:

  • A prospective database of surgically treated brain cavernoma patients (January 1998 - June 2012) was reviewed.
  • Inclusion criteria focused on patients with cavernomas in the brainstem or deep supratentorial structures.

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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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  • Primary outcome: favorable outcome (Glasgow Outcome Scale [GOS] 4 or 5) at 1 year. Secondary outcome: morbidity/mortality (≥1 point drop in GOS).

    • Main Results:

    • Thirty-seven patients underwent surgery, with a mean age of 34.7 years.
    • A favorable outcome (GOS 4 or 5) was achieved in 89.5% of cases (34/37).
    • Two early deaths (5.3%) and 4 cases (10.5%) of decreased GOS were recorded. Mean follow-up was 39 months.

    Conclusions:

    • Surgical resection yielded a high rate of favorable outcomes (89.5%) for brainstem and deep supratentorial cavernomas.
    • Despite a notable morbidity and mortality rate, surgery is the preferred treatment for first-time bleeding, surgically accessible lesions due to high rebleed risks.
    • Radiosurgery is recommended for unresectable lesions where observation is less favorable than intervention.