[Place of the surgery in the management of brainstem cavernomas. Results of a multicentric study].
OBJECTIVE
To compare the outcome between operated and non-operated brainstem cavernomas.


METHODS
Clinical and radiological data of 30 patients harboring 35 brainstem cavernomas were retrospectively reviewed. The mean follow-up period was 47 months. Relationship between the cavernoma and the pi maer was graded. The histology of each operative case was systematically confirmed. The Karnofsky mean score was calculated at admission and at the end of the follow-up period. Patients were classified in three groups according to their outcome grade (Group I=good; Group II=unchanged; Group III=worse). We compared the outcome between operated and non-operated patients. For operated cases, we found several factors of poor outcome. Statistical tests used to compare the groups of patients were Yates modified chi(2) with calculation of the exact probability. Chosen risk was 5%.


RESULTS
Thirty-eight percent of operated patients were permanently disabled after surgery whereas the same proportion was improved. None of the patients in the control group worsened at the mean 47-month follow-up despite the occurrence of two hemorrhagic events. Statistical study showed that treatment modality affected clinical outcome in these patients. Only patients presenting with multiple deficits and progressive neurological deterioration were improved with surgery. Surgical access through the floor of the fourth ventricle was correlated with a poor outcome. Partial removal of the cavernoma increased the risk of future hemorrhage.


CONCLUSIONS
Surgery showed no proof of its efficiency in the management of brainstem cavernomas at the end of the follow-up period. Indications of surgical treatment must be restricted to cases with a severe and progressive neurological deterioration.
Service de Neurochirurgie, CHU Hautepierre, 67098 Strasbourg Cedex. philippeesposito@yahoo.fr
Ph
P
Esposito
S
S
Coulbois
P
P
Kehrli
P
P
Boyer
J-L
JL
Dietemann
P
P
Rousseaux
J
J
Auque
D
D
Maitrot
D000293:Adolescent; D000328:Adult; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000473:pathology; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000209:etiology / Q000473:pathology; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000503:physiopathology*; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D016896:Treatment Outcome