Surgical Management and Functional Outcomes of Cavernous Malformations Involving the Medulla Oblongata

World Neurosurg. 2018 Nov:119:e643-e652. doi: 10.1016/j.wneu.2018.07.229. Epub 2018 Aug 2.

Abstract

Objective: The aim of this study was to evaluate the clinical features, surgical complications, and functional outcomes of the surgical treatment of patients with cavernous malformations (CMs) involving the medulla oblongata.

Methods: The charts of 69 patients undergoing surgical treatment of CMs in the medulla oblongata, pontomedullary, and cervicomedullary junctions between 2011 and 2017 were retrospectively reviewed. Patient demographics, lesion characteristics, operative documents, and patient outcomes were examined.

Results: Of the 69 patients, the male-to-female ratio was 1.3. The mean patient age was 32.6 years, and the mean mRS score was 2.7 on admission. Postoperatively, 21 patients (30.4%) had deficits of cough reflexes, and 6 patients (8.7%) experienced respiratory rhythm disorder and dyspnea. The mean follow-up duration was 35.3 months. At the last follow-up evaluation, the mean mRS score was 1.8, and 53 patients (80.3%) had favorable outcomes, with mRS scores ≤2. The conditions of the patients improved in 45 cases (68.2%), remained unchanged in 11 cases (16.7%), and worsened in 10 cases (15.1%) relative to their preoperative baseline. The independent adverse factors for long-term functional outcome were increased age, multiple hemorrhages, presence of developmental venous anomalies, and lack of perilesional edema.

Conclusions: Respiratory dysfunction and deficits of cough reflexes can commonly occur during the early postoperative period for surgical resection of CMs involving the medulla oblongata. Favorable functional outcomes can be achieved by surgery, especially for younger patients who experience fewer hemorrhages and have lesions with perilesional edema and the absence of developmental venous anomalies.

Keywords: Brainstem; Cavernoma; Cavernous malformations; Medulla oblongata; Surgery; Vascular disorders.

MeSH terms

  • Adolescent
  • Adult
  • Brain Stem Neoplasms / diagnostic imaging
  • Brain Stem Neoplasms / surgery*
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / surgery
  • Child
  • Female
  • Follow-Up Studies
  • Hemangioma, Cavernous, Central Nervous System / diagnostic imaging
  • Hemangioma, Cavernous, Central Nervous System / surgery*
  • Humans
  • Male
  • Medulla Oblongata / diagnostic imaging
  • Medulla Oblongata / surgery
  • Microsurgery
  • Middle Aged
  • Neurosurgical Procedures
  • Postoperative Complications
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult