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Surgical treatment of brainstem cavernomas using diffusion tensor imaging and diffusion tensor tractography.

Krzysztof Majchrzak1, Barbara Bobek-Billewicz2, Anna Hebda2

  • 1Department and Clinical Ward of Neurosurgery, Medical University of Silesia, Sosnowiec, Poland. krzysztof.majchrzak@sum.edu.pl.

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Surgical intervention for brainstem cavernomas after the first hemorrhage offers better outcomes. Advanced imaging like diffusion tensor imaging and diffusion tensor tractography (DTI/DTT) aids in safe surgical planning and complete tumor resection.

Keywords:
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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Imaging

Background:

  • Brainstem cavernomas pose significant risks, including rehemorrhage.
  • Assessing prognosis after initial or subsequent hemorrhages is crucial.
  • Determining optimal surgical indications for brainstem cavernomas is essential.

Purpose of the Study:

  • To evaluate patient prognosis following single or recurrent hemorrhages from brainstem cavernomas.
  • To identify key indicators for surgical intervention in brainstem cavernoma cases.
  • To assess the impact of advanced imaging on surgical outcomes.

Main Methods:

  • Retrospective analysis of 35 patients with brainstem cavernomas.
  • Utilized MRI perfusion-weighted imaging/diffusion-weighted imaging and diffusion tensor imaging/diffusion tensor tractography (DTI/DTT).
  • DTI/DTT guided surgical approach and safe entry zone determination via neuronavigation.

Main Results:

  • Rehemorrhage risk correlates with cavernoma size and volume, not location.
  • Outcomes were superior after the first hemorrhage compared to rehemorrhage.
  • Complete resection (91%) led to better results, though reoperation was sometimes necessary.

Conclusions:

  • Surgical treatment is recommended after the first hemorrhage, particularly for large brainstem cavernomas.
  • DTI/DTT is vital for planning trajectories and safe entry zones, especially for deep cavernomas.
  • Complete cavernoma resection should be prioritized, even if reoperation is required.