title: A single institution series of cavernomas of the brainstem.
abstract: We retrospectively analyzed a series of patients with brainstem cavernomas of the medulla, pons, or midbrain to attempt to define the natural history, indications for surgery, and outcome after surgical resection. Between 1993 and 2008, 52 patients with cavernomas of the brainstem presented to our institute and were managed either surgically or conservatively. Twenty-three patients underwent surgical excision using standard skull base approaches. Outcomes were correlated to the number of preoperative hemorrhages, location of the cavernoma, timing of surgery in relation to the hemorrhage and the preoperative neurological status. Nine patients improved after surgery, 12 deteriorated and two died. In the conservatively managed group, 15 patients had a good outcome, 11 deteriorated and one died. Multiple hemorrhages, poor preoperative neurological status and surgery during the acute phase were predictive of the surgical outcome. Excision of brainstem cavernomas should be considered in patients with symptomatic hemorrhages whose lesions approach the pial surface. Patients with minimal stable neurologic deficits without recurrent bleeds should be managed conservatively.
authors: Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
authors: Girish
authors: G
authors: Menon
authors: C V
authors: CV
authors: Gopalakrishnan
authors: B R M
authors: BR
authors: Rao
authors: Suresh
authors: S
authors: Nair
authors: Jayanand
authors: J
authors: Sudhir
authors: Mridul
authors: M
authors: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult