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Published on: October 20, 2017
[«Cavernous angiomas» of the brainstem. Clinical manifestations, diagnosis and treatment results]
A N Konovalov1, A V Gavryushin1, E A Khukhlaeva1
1Burdenko Neurosurgical Center, Moscow, Russia.
Insights
Differentiating brainstem hematomas from cavernous angiomas (CA) is crucial for treatment. Hematoma patients showed significantly better long-term outcomes after surgery compared to CA patients.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Current literature often groups brainstem hematomas and cavernous angiomas (CA) together.
- This undifferentiated approach hinders accurate surgical indications and outcome prediction.
Purpose of the Study:
- To analyze the diagnostic and treatment experiences with brainstem cavernous angiomas (CA).
- To differentiate outcomes between brainstem hematomas and CAs.
Main Methods:
- Retrospective analysis of 515 patients with brainstem CA (322 surgical, 193 conservative).
- Follow-up included neurological examination, Karnofsky scores, MRI, and CT data for over 5 years.
- Patients were categorized into hematoma (59%) and CA (41%) groups based on MRI, intraoperative, and biopsy findings.
Main Results:
- Brainstem hematomas and CAs exhibit distinct clinical and radiological features.
- Surgical debridement of hematomas led to early improvement in 63% of patients, with 92% showing long-term neurological symptom regression.
- Cavernous angiomas without hemorrhage showed less favorable outcomes, with 73% experiencing clinical impairment post-treatment.
Conclusions:
- Histopathological type of brain lesion is a key predictor for treatment strategy.
- Significant differences in postoperative outcomes exist between brainstem hematomas and cavernous angiomas.
Introduction:
In the current literature, brainstem hematomas and various types of vascular micromalformations are combined into the one group of diseases under the general name «cavernous angioma» (CA). This approach does not make it possible to accurately determine the indications for surgery and predict postoperative outcomes.
Objective:
To analyze our own experience in the diagnosis and treatment of patients with the brainstem CA.
Material And Methods:
There were 515 patients with CA of the brainstem (surgery - 322, conservative treatment - 193 patients) with a follow-up period of more than 5 years. Follow-up survey implied neurological examination, analysis of Karnofsky score, MRI and CT data.
Results:
We identified two main groups of patients after comparison of MRI data, intraoperative findings and biopsy data: group 1 - hematomas (191 patients, 59%), group 2 - CA (131 patients, 41%). Each group was characterized by own clinical and radiological features. Postoperative outcomes depended on the disease. Debridement of hematoma ensured early postoperative improvement in 63% of patients, no changes in 21% of cases and impairment in 16% of patients. Less favorable results were observed in patients with CA and no signs of hemorrhage. Clinical impairment occurred in 73% of cases, improvement - only in 5% of patients. The most significant regression of neurological symptoms in long-term postoperative period was observed in patients with hematomas (92% of patients). These ones noted much better clinical state compared with preoperative condition.
Conclusions:
The type of brain lesion is an important predictor to determine treatment approach. Postoperative outcomes differ significantly in patients with the brainstem hematoma and CA.
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