Brainstem cavernous malformations: Natural history versus surgical management.
While brainstem cavernous malformations were once considered inoperable, improvements in patient selection, surgical exposures, intraoperative MRI-guidance, MR tractography, and neurophysiologic monitoring have resulted in good outcomes in the majority of operated patients. In a consecutive series of 104 patients with brainstem cavernous malformations, only 14% of patients experienced cranial nerve or motor dysfunction that was worse at late follow-up, relative to their preoperative condition. Outcomes were predicted by several factors, including larger lesion size, lesions that crossed the midline, the presence of a developmental venous anomaly, older age, and greater time interval from lesion hemorrhage to surgery. The 14% of patients who experienced a persistent neurological deficit as a result of surgery, while substantial from any perspective, compares favorably with the risks of observation based on a recent meta-analysis. Curative resection is a safe and effective treatment for brainstem cavernous malformations that will prevent re-hemorrhage in symptomatic patients.
Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M780, San Francisco, CA 94143-0112, USA. Electronic address: brian.walcott@ucsf.edu.
Brian P
BP
Walcott
Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M780, San Francisco, CA 94143-0112, USA.
Omar
O
Choudhri
Department of Neurological Surgery, University of California, 505 Parnassus Avenue, M780, San Francisco, CA 94143-0112, USA.
Michael T
MT
Lawton
D000293:Adolescent; D000328:Adult; D001933:Brain Stem / Q000473:pathology; D020787:Central Nervous System Venous Angioma / Q000601:surgery; D003391:Cranial Nerves / Q000473:pathology; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome
Brainstem; Cavernoma; Cavernous malformation; Hemorrhage; Stroke; Surgery