Brainstem cavernous malformations: Natural history versus surgical management

Document Type

Article

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.

Medical Subject Headings

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

Publication Date

6-21-2016

Publication Title

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

E-ISSN

1532-2653

Volume

32

First Page

164

Last Page

5

PubMed ID

27320373

Digital Object Identifier (DOI)

10.1016/j.jocn.2016.03.021

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