Brainstem cavernous malformations: Natural history versus surgical management

J Clin Neurosci. 2016 Oct:32:164-5. doi: 10.1016/j.jocn.2016.03.021. Epub 2016 Jun 16.

Abstract

While brainstem cavernous malformations were once considered inoperable, improvements in patient selection, surgical exposures, intraoperative MRI-guidance, MR tractography, and neurophysiologic monitoring have resulted in good outcomes in the majority of operated patients. In a consecutive series of 104 patients with brainstem cavernous malformations, only 14% of patients experienced cranial nerve or motor dysfunction that was worse at late follow-up, relative to their preoperative condition. Outcomes were predicted by several factors, including larger lesion size, lesions that crossed the midline, the presence of a developmental venous anomaly, older age, and greater time interval from lesion hemorrhage to surgery. The 14% of patients who experienced a persistent neurological deficit as a result of surgery, while substantial from any perspective, compares favorably with the risks of observation based on a recent meta-analysis. Curative resection is a safe and effective treatment for brainstem cavernous malformations that will prevent re-hemorrhage in symptomatic patients.

Keywords: Brainstem; Cavernoma; Cavernous malformation; Hemorrhage; Stroke; Surgery.

MeSH terms

  • Adolescent
  • Adult
  • Brain Stem / pathology
  • Central Nervous System Venous Angioma / surgery
  • Cranial Nerves / pathology
  • Female
  • Hemangioma, Cavernous, Central Nervous System / surgery*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Treatment Outcome