title: Symptomatic cavernous malformations of the brainstem: functional outcome after microsurgical resection.
abstract: Brainstem cavernous malformations are associated with a considerable risk of hemorrhage and subsequent morbidity. This study provides a detailed work-up of clinical and radiological outcome as well as identification of prognostic factors in patients who had suffered from symptomatic hemorrhages. Patients who had undergone surgery of symptomatic BSCMs were evaluated pre- and postoperatively both neurologically and neuroradiologically supplemented by telephone interviews. Additionally, patients were scored according to the Scandinavian Stroke Scale. Multiple uni- and multivariate analyses of possible clinical and radiological prognostic factors were conducted. The study population comprised 35 patients. Mean age at operation was 39.3 ± 13.0 years with microsurgical resection of a total of 37 different BSCMs between 2002 and 2011. Median clinical follow-up was 44.0 months (range 8-116 months). Postoperative MRI showed eventually complete resection of all BSCMs. Postoperative overall outcome revealed complete resolution of neurological symptoms for 5/35 patients, 14/35 improved and 9/35 remained unchanged. 7/35 suffered from a postoperative new and permanent neurological deficit, mostly affecting the facial nerve or hemipareses with mild impairment. Pre- and postoperative Scandinavian Stroke Scale scores were 11.0 ± 2.4 and 11.4 ± 2.2 (p = 0.55). None of the analyzed factors were found to significantly correlate with patients' clinical outcome. Complete resection of brainstem cavernous malformations can be achieved with an acceptable risk for long-term morbidity and surgery-related new deficits (~20 %). Neurological outcome is mainly determined within the first 6 months after surgery. Surgical treatment of brainstem cavernous malformations is recommended in symptomatic patients, in whom the lesion is accessible for surgery.
authors: Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany, christoph.schwartz@med.uni-muenchen.de.
authors: Christoph
authors: C
authors: Schwartz
authors: Andreas
authors: A
authors: Grillhösl
authors: Christian
authors: C
authors: Schichor
authors: Bogdana
authors: B
authors: Suchorska
authors: Alexander
authors: A
authors: Romagna
authors: Jörg-Christian
authors: JC
authors: Tonn
authors: Stefan
authors: S
authors: Zausinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020295:Brain Stem Neoplasms / Q000601:surgery*; D002648:Child; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000601:surgery*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000592:standards*; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
references: J Neurosurg. 1995 Nov;83(5):820-4
references: 7472549
references: J Neurosurg. 1994 Mar;80(3):422-32
references: 8113854
references: J Neurosurg. 2003 Jul;99(1):31-7
references: 12854740
references: Minim Invasive Neurosurg. 2000 Dec;43(4):201-7
references: 11270832
references: J Neurosurg. 1990 Aug;73(2):174-80
references: 2366073
references: Neurosurgery. 2011 Feb;68(2):403-14; discussion 414-5
references: 21654575
references: J Clin Neurosci. 2010 Jan;17(1):74-9
references: 20005720
references: Acta Neurochir Suppl (Wien). 1991;53:37-41
references: 1803882
references: Neurosurg Rev. 1997;20(2):87-93
references: 9226665
references: Surg Neurol. 2003 Jun;59(6):444-54; discussion 454
references: 12826334
references: J Neurol Neurosurg Psychiatry. 2013 Feb;84(2):194-200
references: 23085932
references: Neurosurgery. 1993 May;32(5):730-5; discussion 735-6
references: 8492847
references: J Neurosurg. 1991 Nov;75(5):702-8
references: 1919691
references: Neurosurgery. 1990 Mar;26(3):449-56; discussion 456-7
references: 2320214
references: Neurosurg Rev. 2002 Mar;25(1-2):1-53; discussion 54-5
references: 11954761
references: Acta Neurochir (Wien). 2002 Sep;144(9):869-78; discussion 878
references: 12376768
references: Neurosurgery. 2006 Feb;58(2):322-30; discussion 322-30
references: 16462486
references: Neurosurgery. 1986 Feb;18(2):162-72
references: 3960293
references: Am J Phys Med Rehabil. 1995 Jan-Feb;74(1):9-18
references: 7873120
references: Neurosurgery. 2005 Jun;56(6):1203-12; discussion 1212-4
references: 15918936
references: J Neurosurg. 1999 Jan;90(1):50-8
references: 10413155
references: Neurochirurgia (Stuttg). 1976 Mar;19(2):59-68
references: 1264322
references: Neurosurgery. 1998 Jun;42(6):1229-36; discussion 1236-8
references: 9632180
references: Zentralbl Neurochir. 1991;52(1):25-32
references: 1862673
references: Acta Neurochir (Wien). 2006 Apr;148(4):405-14
references: 16311840
references: Neurology. 1992 Feb;42(2):289-98
references: 1736156
references: Acta Neurochir (Wien). 1994;130(1-4):35-46
references: 7725941
references: Int Disabil Stud. 1988;10(2):64-7
references: 3042746
references: J Neurosurg. 1995 Jul;83(1):56-9
references: 7782850
references: Neurosurgery. 2013 Apr;72(4):573-89; discussion 588-9
references: 23262564
references: Neurochirurgie. 2007 Jun;53(2-3 Pt 2):243-50
references: 17507050
references: Acta Neurochir (Wien). 2008 Sep;150(9):879-86; discussion 887
references: 18754072
references: Neurosurgery. 2011 Sep;69(3):689-95
references: 21508880