title: Surgical management of brainstem cavernous malformations.
abstract: Bleeding from brainstem cavernomas may cause severe deficits due to the absence of non-eloquent nervous tissue and the presence of several ascending and descending white matter tracts and nerve nuclei. Surgical removal of these lesions presents a challenge to the most surgeons. The authors present their experience with the surgical treatment of 43 patients with brainstem cavernomas. Important aspects of microsurgical anatomy are reviewed. The surgical management, with special focus on new intraoperative technologies as well as controversies on indications and timing of surgery are presented. According to several published studies the outcome of brainstem cavernomas treated conservatively is poor. In our experience, surgical resection remains the treatment of choice if there was previous hemorrhage and the lesion reaches the surface of brainstem. These procedures should be performed by experienced neurosurgeons in referral centers employing all the currently available technology.
authors.affiliation: Neurosurgical Department, Neurological Institute of Curitiba, Jeremias Maciel Perreto 300, Curitiba, PR 81210-310, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ramina
authors.forename: Tobias Alécio
authors.initials: TA
authors.lastname: Mattei
authors.forename: Paulo Henrique Pires
authors.initials: PH
authors.lastname: de Aguiar
authors.forename: Murilo Sousa
authors.initials: MS
authors.lastname: Meneses
authors.forename: Vinicius Ricieri
authors.initials: VR
authors.lastname: Ferraz
authors.forename: Rogério
authors.initials: R
authors.lastname: Aires
authors.forename: Dierk F B
authors.initials: DF
authors.lastname: Kirchhoff
authors.forename: Daniel
authors.initials: D
authors.lastname: de Carvalho Kirchhoff
mesh_terms: D001933:Brain Stem / Q000601:surgery*; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies