Surgical management of brain-stem cavernomas.
We present a series of seven patients who were operated on for symptomatic brain-stem cavernomas. The following approaches were used: medial suboccipital (N = 4), lateral suboccipital (N = 1), subtemporal-transtentorial (N = 1), and frontal transcortical-transventricular-subchorioidal-trans velum interpositum (N = 1). Intraoperative motor (N = 4) and somatosensory (N = 1) evoked potential monitoring revealed temporary changes in 3 patients. Immediately postoperatively, the following additional deficits were observed in 6 patients: oculomotor nerve paresis (N = 2), abducens nerve paresis (N = 3), facial nerve paresis (N = 2), deafness (N = 1), and increased ataxia (N = 3). One patient died due to septic complications not related to surgery. After a mean observation time of 2 years, 2 patients had improved, 3 were unchanged, and 1 patient deteriorated as compared to his preoperative status. In conclusion, surgical treatment of brain-stem cavernomas, although carrying a significant risk of temporary neurological deterioration is recommended in symptomatic patients in whom the cavernoma seems to reach the surface of the brain-stem. Intraoperative functional topographic mapping and monitoring have proven useful tools lowering the surgical risks in these patients.
Pechstein
U
U
Department of Neurosurgery, University of Bonn, Fed. Rep. of Germany.
Zentner
J
J
Van Roost
D
D
Schramm
J
J
D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D001933:Brain Stem / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed