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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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Brainstem cavernous malformations: Natural history versus surgical management
Brian P Walcott1, Omar Choudhri1, Michael T Lawton1
1Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M780, San Francisco, CA 94143-0112, USA.
Summary
Surgical intervention for brainstem cavernous malformations offers good outcomes for most patients. Advances in surgical techniques and monitoring have made these once inoperable lesions treatable, with low rates of persistent neurological deficits.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Brainstem cavernous malformations (BCMs) were historically considered inoperable due to high risks.
- Significant advancements in surgical techniques and neuro-monitoring have emerged.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical resection for BCMs.
- To identify predictors of surgical outcomes in patients with BCMs.
Main Methods:
- Consecutive series of 104 patients with BCMs undergoing surgical resection.
- Detailed analysis of preoperative factors and postoperative outcomes, including neurological deficits.
- Comparison of surgical risks with observational data.
Main Results:
- The majority of operated patients achieved good outcomes.
- Only 14% experienced worsened neurological function post-surgery compared to preoperative status.
- Predictive factors for poorer outcomes included larger lesion size, midline crossing, developmental venous anomalies, older age, and longer interval from hemorrhage to surgery.
Conclusions:
- Curative resection is a safe and effective treatment for symptomatic brainstem cavernous malformations.
- Surgery prevents re-hemorrhage and offers favorable outcomes compared to observation.
- Improved surgical strategies have transformed the management of BCMs.
