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Surgical management of brain-stem cavernomas
U Pechstein1, J Zentner, D Van Roost
1Department of Neurosurgery, University of Bonn, Fed. Rep. of Germany.
Neurosurgical Review
|January 1, 1997
Summary
Surgical treatment for symptomatic brain-stem cavernomas can lead to temporary deficits but is recommended for accessible lesions. Intraoperative monitoring aids in reducing surgical risks for these complex brain tumors.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurosurgery
Background:
- Brain-stem cavernomas are vascular malformations that can cause significant neurological symptoms.
- Surgical intervention for brain-stem cavernomas is challenging due to the critical location and potential for neurological deficits.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for symptomatic brain-stem cavernomas.
- To assess the safety and efficacy of various surgical approaches and intraoperative monitoring techniques.
Main Methods:
- A series of seven patients with symptomatic brain-stem cavernomas underwent surgical resection.
- Surgical approaches included medial suboccipital, lateral suboccipital, subtemporal-transtentorial, and frontal transcortical routes.
- Intraoperative monitoring utilized motor and somatosensory evoked potentials.
Main Results:
- Postoperative neurological deficits were observed in six patients, including cranial nerve palsies and ataxia.
- One patient experienced septic complications unrelated to surgery, and another died.
- After a mean follow-up of two years, two patients improved, three remained unchanged, and one deteriorated.
Conclusions:
- Surgical treatment for symptomatic brain-stem cavernomas is recommended for accessible lesions, despite risks of temporary neurological deterioration.
- Intraoperative functional topographic mapping and monitoring are valuable tools for minimizing surgical risks.