title: Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions.
abstract: BACKGROUND
  Despite the increased risk of hemorrhage and deteriorating neurological function of once-bled cerebral cavernous malformations (CM), the management of eloquently located CMs remains controversial.
  
  
  METHODS
  All eloquently located CMs (n = 45) surgically treated between 03/2006 and 04/2011 in our department were consecutively evaluated. Eloquence was characterized according to Spetzler and Martin's definition. The following locations were approached: brainstem, n = 16; sensorimotor, n = 8; visual pathway, n = 7; cerebellum (deep nuclei and peduncles), n = 7; basal ganglia, n = 4, and language, n = 3. Follow-up data was available for 41 patients (91 %) with a median interval of 14 months. Outcomes were evaluated according to the Glasgow outcome and the modified Rankin scale.
  
  
  RESULTS
  Immediately after surgery, 47 % (n = 21) had a new deficit. At follow-up, 80 % (n = 36) recovered to at least preoperative status or were better than before surgery, 9 % (n = 4) exhibited a slight, and 7 % (n = 3) had a moderate neurological impairment. Only two cases (4 %) with a new permanent severe deficit were observed, both related to dorsal brainstem surgery. The outcome after the surgery of otherwise located brainstem CMs was as beneficial as that for non-brainstem CMs. Patients with initially poor neurological performance fared worse than oligosymptomatic patients.
  
  
  CONCLUSIONS
  Despite the high postoperative transient morbidity, the majority improved profoundly during follow-ups. Compared with natural history, surgical treatment should be considered for all eloquent symptomatic CMs. Dorsal brainstem location and poor preoperative neurological status are associated with an increased postoperative morbidity.
authors: Department of Neurosurgery, Technical University of Munich, Munich, Germany. maria.wostrack@lrz.tum.de
authors: Maria
authors: M
authors: Wostrack
authors: Ehab
authors: E
authors: Shiban
authors: Kathrin
authors: K
authors: Harmening
authors: Thomas
authors: T
authors: Obermueller
authors: Florian
authors: F
authors: Ringel
authors: Yu-Mi
authors: YM
authors: Ryang
authors: Bernhard
authors: B
authors: Meyer
authors: Michael
authors: M
authors: Stoffel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000209:etiology / Q000601:surgery*; D001933:Brain Stem / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000150:complications; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications; D016634:Radiosurgery / Q000009:adverse effects; D016896:Treatment Outcome