title: Minimally invasive resection of brainstem cavernous malformations: surgical approaches and clinical experiences with 38 patients.
abstract: OBJECTIVE
  The purpose of this study is to provide a retrospective review of patients with brain stem cavernous malformation (BSCM) at single institution.
  
  
  METHODS
  Clinical courses were retrospectively reviewed for 38 consecutive patients who underwent microsurgical resection of symptomatic BSCMs in the sub-acute phase between January 2000 and December 2009. Microsurgery was performed with the help of intraoperative neuronavigation and neurophysiological monitoring. The baseline information of patients, lesion characteristics, surgical approaches, and follow-up outcomes were analyzed.
  
  
  RESULTS
  All 38 patients received microsurgical resections without surgery-related mortality, and 37 patients were completely extirpated. 21 patients who experienced neurological deficits had functional improvement after surgery, 15 patients had no change in the neurological status over time to their preoperative condition or better, and 2 patients deteriorated. During the follow-up, 28 patients had resumed activities of daily living (KPS=90-100), 8 patients were able to self-care with some efforts (KPS=70-80) and other 2 patients needed considerable assistance. None of the operated patient had recurrent hemorrhage. Postoperative complications included new cranial nerve deficits in 13 patients, motor deficits in 3 patients, and new sensory disturbances in 6 patients.
  
  
  CONCLUSIONS
  Complete surgical resection could be achieved through careful preoperative planning, selection of the optimal operative approach, a meticulous microsurgical technique and intraoperative navigation. However, taking into account the relatively high postoperative morbidity, complete resection is not always the goal for BSCMs, especially for those deep-seated lesions.
authors: The Affiliated Bayi Brain Hospital, The Military General Hospital of Beijing, PLA, Beijing 100700, China. Electronic address: 13801187508@sina.cn.
authors: Li-Hua
authors: LH
authors: Chen
authors: The Affiliated Bayi Brain Hospital, The Military General Hospital of Beijing, PLA, Beijing 100700, China. Electronic address: zhanghongtian007@126.com.
authors: Hong-Tian
authors: HT
authors: Zhang
authors: Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, Chuangchu Street 45, Beijing 100053, China.
authors: Ling
authors: L
authors: Chen
authors: Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, Chuangchu Street 45, Beijing 100053, China.
authors: Li-Xu
authors: LX
authors: Liu
authors: The Affiliated Bayi Brain Hospital, The Military General Hospital of Beijing, PLA, Beijing 100700, China. Electronic address: zjxuruxiang@163.com.
authors: Ru-Xiang
authors: RX
authors: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D020295:Brain Stem Neoplasms / Q000473:pathology / Q000601:surgery*; D003391:Cranial Nerves / Q000601:surgery; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brainstem; Cavernomas; Cavernous malformation; Microsurgery; Skull base