An Integrated Paradigm for Brainstem Cavernoma Surgery : Combining Defined Surgical Timing with Diffusion Tensor...

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Hemorrhagic brainstem cavernous malformations pose significant surgical challenges.
• Optimal surgical timing and the role of advanced imaging in preserving neurological function remain critical considerations.

Purpose of the Study:

• To evaluate the impact of surgical timing (hemorrhage-to-surgery interval) on outcomes.
• To assess the utility of preoperative diffusion tensor imaging (DTI) tractography for corticospinal tract (CST) preservation during surgery.

Main Methods:

• Retrospective cohort study of 41 patients with hemorrhagic brainstem cavernous malformations.
• Patients stratified by hemorrhage-to-surgery interval: acute (<3 weeks), subacute (3-8 weeks), and delayed (>8 weeks).
• Preoperative DTI tractography for CST mapping used in 24 patients; 17 did not have DTI.

Main Results:

• Delayed surgery (>8 weeks) independently predicted unfavorable outcomes at discharge.
• Preoperative DTI was associated with significantly lower rates of postoperative motor deterioration (12.5% vs. 47.1%).
• DTI's protective effect was most pronounced in the delayed surgery group; persistent motor deficit strongly predicted long-term disability.

Conclusions:

• Surgery delayed beyond 8 weeks predicts poorer early functional recovery.
• Preoperative DTI tractography reduces postoperative motor deficits, particularly in delayed surgery cases.
• A risk-stratified strategy emphasizing timely intervention (within 8 weeks) and DTI use is proposed to optimize functional outcomes.