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The Brainstem Cavernoma Case Series: A Formula for Surgery and Surgical Technique
Marcos Tatagiba1, Guilherme Lepski1, Marcel Kullmann1
1Department of Neurosurgery, University of Tuebingen Medical Center, 72074 Tübingen, Germany.
Medicina (Kaunas, Lithuania)
|September 28, 2023
Summary
Surgical removal of deep-seated brainstem cavernomas (BS CM) is complex but achievable. Advanced techniques like neuronavigation and brainstem mapping enable complete removal with outcomes comparable to superficial BS CM.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Cavernous malformations (CM) are low-flow vascular malformations.
- Surgical removal of brainstem CMs (BS CM) carries high morbidity, with no consensus on treating deep-seated lesions.
Purpose of the Study:
- To compare surgical outcomes of deep-seated BS CMs versus superficial BS CMs.
- To evaluate the efficacy of advanced surgical techniques for deep-seated BS CMs.
Main Methods:
- Retrospective analysis of 34 patients with BS CMs (20 superficial, 14 deep-seated).
- Utilized MRI, diffusion tensor imaging (DTI), 3D neuronavigation, and electrophysiological brainstem mapping for deep-seated lesions.
Main Results:
- Complete removal achieved in 91.2% of all patients.
- Deep-seated BS CMs had a 92.9% complete removal rate with comparable outcomes to superficial BS CMs (5.9% new deficits in both groups).
- Median follow-up was 5.8 years for deep-seated and 3.6 years for superficial BS CMs.
Conclusions:
- Treatment of BS CMs is challenging but feasible.
- Less invasive approaches, brainstem mapping, neuronavigation, and blunt dissection allow complete removal of selected deep-seated BS CMs.
- Outcomes for deep-seated BS CMs are comparable to superficial ones, with good functional results.
