Holmes tremor: a delayed complication after resection of brainstem cavernomas.

Area of Science:

• Neurosurgery
• Neurology
• Medical Complications

Background:

• Brainstem cavernomas are vascular malformations requiring surgical intervention.
• Holmes tremor (HT) is a debilitating movement disorder.
• Delayed complications after brainstem cavernoma resection are not fully understood.

Purpose of the Study:

• To investigate the occurrence of Holmes tremor as a delayed complication after brainstem cavernoma resection.
• To identify potential predictive factors for Holmes tremor development.
• To evaluate treatment options for post-resection Holmes tremor.

Main Methods:

• Multi-center case series of 20 patients with Holmes tremor post-brainstem cavernoma resection.
• Analysis of 1274 brainstem cavernoma cases to identify predictive factors.
• Electromyography, accelerometry, and tractography in select cases.
• Statistical analysis to correlate cavernoma location with HT onset.

Main Results:

• Holmes tremor can occur as a delayed complication despite adherence to safe entry zones and successful surgery.
• Midbrain cavernoma location was significantly associated with the onset of Holmes tremor (p < 0.0005).
• Deep brain stimulation (DBS) effectively treated HT in three patients, leading to significant tremor regression.

Conclusions:

• Holmes tremor is a potential delayed complication of brainstem cavernoma resection, irrespective of surgical technique.
• Midbrain location of brainstem cavernomas is a significant predictor of Holmes tremor.
• Further research into anatomical and neurophysiological factors is needed to prevent this complication.