Microsurgery and radiosurgery for brainstem cavernomas: effective and complementary treatment options.
OBJECTIVE
To evaluate treatment options for brainstem cavernous malformations (BSCMs) using the results from a center with long-standing experience in microsurgical resection and Gamma Knife radiosurgery (GKRS) treatment of BSCMs.


METHODS
Study participants were 67 symptomatic patients with BSCMs who were treated either microsurgically (n = 29) or radiosurgically (n = 38). Patients were followed for a minimum of 2 years (median, 7.7 years). A recent follow-up was performed.


RESULTS
Patients receiving surgical treatment had mainly large, superficially seated lesions and experienced preoperative hemorrhages more often and presented with higher preoperative modified Rankin Scale scores. Patients receiving GKRS harbored smaller, deep-seated lesions, reflecting a selection bias. In both treatment groups, patients presented with significantly better modified Rankin Scale scores at follow-up than before intervention. Overall annual preoperative hemorrhage rates were 3.2% in microsurgery patients and 2.3% in radiosurgery patients. In the preoperative observation period, the rehemorrhage rate was 25.1% for microsurgery patients and 7.2% for radiosurgery patients. Hemorrhage rate after GKRS decreased significantly to 0.6% after 2 years. The postoperative hemorrhage rate was 8.8% but only for microsurgery patients with residual lesions. Advancements in microsurgical techniques improved surgical outcomes, resulting in a high total excision rate in the modern era.


CONCLUSIONS
In the treatment of BSCM, patient selection and timing of surgery are crucial. If applied in a multidisciplinary neurosurgical center, microsurgery and radiosurgery are complementary treatment options that both result in reduced bleeding rates and improvement of clinical outcome.
Department of Neurosurgery, Medical University Vienna, Vienna, Austria. Electronic address: josa.frischer@meduniwien.ac.at.
Josa M
JM
Frischer
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Brigitte
B
Gatterbauer
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Sabrina
S
Holzer
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Ioannis
I
Stavrou
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Andreas
A
Gruber
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Klaus
K
Novak
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Wei-Te
WT
Wang
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Andrea
A
Reinprecht
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Ayguel
A
Mert
Department of Radiology, MR Centre of Excellence, Medical University Vienna, Vienna, Austria.
Siegfried
S
Trattnig
Department of Radiology, Medical University Vienna, Vienna, Austria.
Ammar
A
Mallouhi
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Klaus
K
Kitz
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Engelbert
E
Knosp
D000293:Adolescent; D000328:Adult; D000368:Aged; D001933:Brain Stem / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging; D005260:Female; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000473:pathology / Q000601:surgery; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011149:Pons / Q000473:pathology / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013788:Thalamus / Q000473:pathology / Q000601:surgery; D055815:Young Adult
Brainstem cavernous malformations; Hemorrhage; Microsurgery; Radiosurgery