Clinical Analysis of Ten Cases with Surgically Treated Brain Stem Cavernous Angiomas.

Mizoi, Kazuo; Yoshimoto, Takashi; Suzuki, Jirô

doi:10.1620/tjem.166.259

Cited by 26 publications

(18 citation statements)

References 12 publications

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“…A total of 64 OPH CM cases were identified. 2,[8][9][10][12][13][14][15]18,19,21,22,[25][26][27][29][30][31][36][37][38][39][40][41][42][46][47][48]51,52,[57][58][59][60][61][62][63][64]67,68 We also report an additional case in this paper, making a total of 65 cases that were reviewed. Each case was analyzed for clinical presentation, lesion location, radiographic features, surgical treatment, and neurological and visual outcome (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Liu

Lü

Raslan

et al. 2010

FOC

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Object Cavernous malformations (CMs) of the optic pathway and hypothalamus (OPH) are extremely rare. Patients with these lesions typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retroorbital pain, and nausea. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature for reported cases of OPH CMs to analyze clinical and radiographic presentations as well as surgical approaches and neurological outcomes. Methods A MEDLINE/PubMed search was performed, revealing 64 cases of OPH CMs. The authors report an additional case in the study, making a total of 65 cases. Each case was analyzed for clinical presentation, lesion location, radiographic features, treatment method, and visual outcome. Results In 65 patients with OPH CMs, the optic chiasm was affected in 54 cases, the optic nerve(s) in 35, the optic tract in 13, and the hypothalamus in 5. Loss of visual field and acuity was the most common presenting symptom (98%), followed by headache (60%). The onset of symptoms was acute in 58% of patients, subacute in 15%, and chronic progressive in 26%. Computed tomography scans revealed hyperdense suprasellar lesions, with calcification visible in 56% of cases. Magnetic resonance imaging typically demonstrated a heterogeneous lesion with mixed signal intensities suggestive of blood of different ages. The lesion was often surrounded by a peripheral rim of hypointensity on T2-weighted images in 60% of cases. Minimal or no enhancement occurred after the administration of gadolinium. Hemorrhage was reported in 82% of cases. Most patients were surgically treated (97%) using gross-total resection (60%), subtotal resection (6%), biopsy procedure alone (6%), biopsy procedure with decompression (23%), and biopsy procedure followed by radiation (2%). Those patients who underwent gross-total resection had the highest rate of visual improvement (85%). Two patients were treated conservatively, resulting in complete blindness in 1 patient and spontaneous recovery of vision in the other patient. Conclusions Cavernous malformations of the OPH are rare and challenging lesions. Gross-total resection of these lesions is associated with favorable visual outcomes. Emergent surgery is warranted in patients presenting with chiasmal apoplexy to prevent permanent damage to the visual pathway.

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Section: Methodsmentioning

confidence: 99%

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Liu

Lü

Raslan

et al. 2010

FOC

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“…19 reviewed 20 cases of brainstem CMs with a positive postoperative course (excellent, n = 7; good, n = 12; not reported, n = 1); 9,10,19,25,29,31,37,41,44,45,50 however, 2 patients presented with mild persistent worsening of neurological status. 21,31 These authors attributed favorable results to the anatomical and physiological features of CMs, which typically displace rather than invade neurostructures; these ideas have also been stated in other studies.…”

Section: Functional Outcomementioning

confidence: 99%

Surgical management of pediatric brainstem cavernous malformations

Li¹,

Hao²,

Tang³

et al. 2014

PED

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Object The goal of this study was to evaluate surgical outcomes of pediatric brainstem cavernous malformations (CMs) and identify the risk factors associated with postoperative full recovery and rebleeding. Methods The clinical charts and radiographs from a series of 52 pediatric patients (37 male and 15 female; mean age 12.2 years; range 1–17 years) who underwent surgery for brainstem CMs between 1996 and 2011 were reviewed. Follow-up evaluation measures were obtained retrospectively. Neurological function was evaluated using the modified Rankin Scale (mRS) score. Results The lesion locations among the 52 patients included the midbrain (n = 7, 13.5%), pons (n = 38, 73.1%), and medulla (n = 7, 13.5%). The mean duration of symptoms was 18.5 months, and the preoperative annual hemorrhage and rebleeding rates were 12.3% and 32.5% per patient-year, respectively. The mean lesion size was 2.1 cm. Gross-total resection without surgery-related death was achieved in 49 patients (94.2%). Immediate postoperative reduced neurological function was observed in 17 patients (32.7%). Surgical morbidities developed in 25 patients (48.1%) and remained in 11 patients (21.2%) after 7.9 years of follow-up. The mean mRS scores at admission, discharge after surgery, 3 and 6 months postsurgery, and recent evaluation were 2.0, 2.3, 2.0, 1.5, and 1.0, respectively. The postoperative mRS scores at 6 months (p < 0.001) and on recent evaluation (p < 0.001) were significantly lower than those at admission. Postoperative rebleeding occurred in 2 patients, and the postoperative annual rebleeding rate was 0.5% per patient-year. By the most recent evaluation, 10 patients (19.2%) had achieved full recovery and all patients were either improved (n = 32, 61.5%) or unchanged (n = 20, 38.5%). The adverse predictors for full recovery included age ≥ 12 years (HR 0.230, p = 0.021), ≥ 2 preoperative hemorrhages (HR 0.124, p = 0.048), and poor preoperative status (HR 0.197, p = 0.040). An HR < 1 predicted poor complete recoveries. The single risk factor predicting postoperative rebleeding was incomplete resection (χ2 = 4.340, p = 0.037). Conclusions Fair outcomes for pediatric brainstem CMs could be obtained through surgery, but only a few patients achieved full recovery. Thus, to minimize surgical morbidity, surgical planning must be tailored to individual patients in all cases in which an operation is warranted. Complete resection must be attempted to reduce the risk of postoperative rebleeding. The predictors associated with complete postoperative recovery were referential for determining treatment.

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“…Among brainstem CMs, 60% of all hemorrhages were found to be symptomatic. 19 A very high initial postoperative morbidity rate (29%-67%) is related to postoperative edema and surgical manipulation. 1 Several series have reported a tracheostomy and/ or gastrostomy rate of approximately 10%.…”

Section: Brainstem Cmsmentioning

confidence: 99%

Management of incidental cavernous malformations: a review

Dalyai

Ghobrial

Awad

et al. 2011

FOC

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Cavernous malformations (CMs) are angiographically occult vascular malformations that are frequently found incidentally on MR imaging. Despite this benign presentation, these lesions could cause symptomatic intracranial hemorrhage, seizures, and focal neurological deficits. Cavernomas can be managed conservatively with neuroimaging studies, surgically with lesion removal, or with radiosurgery. Considering recent studies examining the CM's natural history, imaging techniques, and possible therapeutic interventions, the authors provide a concise review of the literature and discuss the optimal management of incidental CMs.

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Clinical Analysis of Ten Cases with Surgically Treated Brain Stem Cavernous Angiomas.

Cited by 26 publications

References 12 publications

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Surgical management of pediatric brainstem cavernous malformations

Management of incidental cavernous malformations: a review

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