Brainstem cavernomas: a surgical challenge

Abstract

Objective: The authors show their experience with brainstem cavernomas, comparing their data with the ones of a literature review. Methods: From 1998 to 2009, 13 patients harboring brainstem cavernomas underwent surgical resection. All plain films, medical records and images were reviewed in order to sample the most important data regarding epidemiology, clinical picture, radiological findings and surgical outcomes, as well as main complications. Results: The mean age was 42.4 years (ranging from 19 to 70). No predominant gender: male-to-female ratio, 6:7. Pontine cases were more frequent. Magnetic resonance imaging was used as the imaging method to diagnose cavernomas in all cases. The mean follow-up was 71.3 months (range of 1 to 138 months). Clinical presentation was a single cranial nerve deficit, VIII paresis, tinnitus and hearing loss (69.2%). All 13 patients underwent resection of the symptomatic brainstem cavernoma. Complete removal was accomplished in 11 patients. Morbidity and mortality were 15.3 and 7.6%, respectively. Conclusions: Cavernomas can be resected safely with optimal surgical approach (feasible entry zone) and microsurgical techniques, and the goal is to remove all lesions with no cranial nerves impairment. Keywords

Surgical results of brainstem cavernous malformation haemorrhage

“…The average modified Ranking Score (mRS) had a mean of 2.36 and median of 2 (Table I), and in the last followup assessment, the average mRS score had a mean of 1.84 and median of 1. The mean follow-up period was 4.64 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) years. Compared with their preoperative states, 14 patients (56%) recovered, 7 (28%) remained unchanged, 3 (12%) got worse and 1 (4%) died.…”

“…In a series involving 13 cases, De Aguiar et al reported that the admission complaints were cranial nerve paralysis (7 and 8) in 92% of the patients, hemiparesis in 7% and headache in 7%. Only one patient recovered from cranial nerve paralysis in the postoperative period (2). In a study involving 36 cases by Samii et al, it was reported that 72% of the patients had cranial nerve paralysis, 36% had motor paralysis and 47% had sensory loss (18).…”

Mortality in Patients with Brainstem Cavernous Malformations

“…The most commonly reported cause of death was postoperative cranial nerve palsy with consecutive respiratory failure/pneumonia in 10 patients (24.4%) [7,[10][11][12][22][23][24][25]. In 7 patients (17.1%), the causes of death were not further clarified; however, it was stated that the death was attributable to BSCM surgery [16,19,[26][27][28][29][30]. Both cardiopulmonary arrest and re-bleeding of incomplete resected BSCM led to death in 3 patients (each 7.3%) [5,[31][32][33][34].…”

Cavernoma Intraventricular a Nível de Forame de Monroe

“…O exame de imagem padrão-ouro para o diagnóstico de cavernomas é a RM 13 , e isto se deve à sua alta resolução espacial e a uma grande sensibilidade na detecção de produtos de degradação da hemoglobina 1 . O achado clássico em T1 costuma ser uma lesão arredondada com aspecto em "pipoca" 1 , ou seja, de aparência reticulada e com intensidades de sinal mistas 5,13 . Também é característica a presença de halo de hipossinal em T2 devido à deposição de hemossiderina 1 , situação esta que resulta de hemorragias microscópicas 19 .…”