Deep and brainstem cavernomas: a consecutive 8-year series

Mathiesen, Tiit; Edner, Göran; Kihlström, Lars

doi:10.3171/jns.2003.99.1.0031

Cited by 193 publications

(103 citation statements)

References 20 publications

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“…10,11,14,19,22,30,34,37,38,42,47,51 Among these studies, Tarnaris et al 47 reported fairly poor outcomes, with 53.3% of patients exhibiting worsening conditions, and cited a neurological deterioration of 10% per patient year. An extremely malignant prognosis was reported with a mortality rate of 20%.…”

Section: Functional Outcomesmentioning

confidence: 99%

Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery

Li¹,

Hao²,

Tang³

et al. 2014

PED

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Object The aim of this study was to investigate the clinical appearance of untreated pediatric brainstem cavernous malformations (CMs) and to identify the hemorrhage risks and functional outcomes. Methods All pediatric patients with a diagnosis of brainstem CM between 1985 and 2012 were registered. The clinical chart and radiographs were recorded, and follow-up evaluations were obtained prospectively. Results A total of 85 patients (69.4% male) were included with a mean age of 12.7 years. Sixty-seven patients (78.8%) had prior hemorrhage, and 6 patients (7.1%) were asymptomatic. There were 15 midbrain lesions, 53 pons lesions, and 17 medulla lesions. The mean lesion size was 1.9 cm. During a total of 401.6 patient-years of follow-up, 47 hemorrhages occurred in 37 patients, and the annual hemorrhage rate was 11.7% per patient-year. The mean hemorrhage interval was 47.8 months. The hemorrhage risk declined over time, especially after the first 2 years. Both a lesion size ≥ 2 cm (hazard ratio [HR] 2.122, p = 0.037) and the presence of perilesional edema (HR 2.192, p = 0.039) predicted future hemorrhage and were associated with a high annual hemorrhage rate. The hemorrhage-free survival at 6 months was 85.7%, and at 1, 5, 10, and 15 years was 71.5%, 49.4%, 27.5%, and 13.7%, respectively. At the most recent functional evaluation, 33 patients (38.8%) had improved, 32 (37.6%) had stabilized, and 20 (23.5%) had worsened, without any deaths. Twenty-two patients (25.9%) obtained a full recovery. Prospective hemorrhage (HR 0.191, p = 0.003) was the adverse predictor for full recovery. Full recovery primarily occurred within the first 12 months, after which the chance of full recovery decreased. The cumulative percentage of complete recovery at 6 months was 32.7%, and at 1, 3, and 5 years was 40.8%, 43.6%, and 49.2%, respectively. Conclusions In this study the hemorrhage rate was relatively high in pediatric brainstem CMs, although the functional outcome was acceptable. The decline in hemorrhage risk and the identified adverse predictors in this study were helpful for clinicians and patients when deciding on treatment. Referral bias and the insufficient follow-up period of the study were highlighted as limitations.

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Section: Functional Outcomesmentioning

confidence: 99%

Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery

Li¹,

Hao²,

Tang³

et al. 2014

PED

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“…These results compare well with the results of previous series (Table 2). 3,5,8,[15][16][17]21,24,26,31,33,36,38,41 Differences in tumor location, dimension, histology, surgical technique, and grades of resection, along with the absence of a specific subgroup analysis in terms of different surgical approaches, make any comparison difficult. In addition, in our series the small sample size of each group of patients, where different grades of resection could be achieved, prevents further analysis and making definitive conclusions.…”

Section: Discussionmentioning

confidence: 99%

The lateral infratrigeminal transpontine window to deep pontine lesions

Ferroli

Schiariti

Cordella

et al. 2015

JNS

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S urgery of intraaxial brainstem lesions has been shown to be feasible and is now being performed in selected patients despite the risk of functional brainstem damage. 4,15,20,31 There are many variables that affect the results of this surgery such as patient selection, surgical techniques, and available technologies. In addition, there is currently no consensus surrounding the decision-making process that guides the surgeon to choose this approach. This is particularly true when this surgery is under consideration for deep pontine lesions that require a brainstem incision to be exposed. In fact, the pons remains one of the most protected and inaccessible areas of the brain because its exposition is obstructed by the cerebellum posteriorly, by the petrous bone laterally, and by septic nasal cavities abbreviatioNs CMAP = compound muscle action potential; CN = cranial nerve; DTI = diffusion tensor imaging; GTR = gross-total resection; MEP = motor evoked potential; mRS = modified Rankin Scale; SSEP = somatosensory evoked potential; STR = subtotal resection.

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“…Small hypointense lesion on T 2 * -weighted images also indicates cavernous malformation or capillary telangiectasia. 5,17,24) These vascular malformations should be ruled out in the assessment of microbleeds.…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Microbleeds in Hemodialysis Patients Detected by T2*-Weighted Gradient-Echo Magnetic Resonance Imaging

Yokoyama¹,

Hirano

Uomizu³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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The incidence and characteristics of microbleeds in hemodialysis (HD) patients were investigated to elucidate the clinical significance with T 2 *-weighted gradient-echo magnetic resonance (MR) imaging. The 57 patients with chronic renal failure maintained by HD had no previous history of stroke. The control group consisted of 53 patients without previous history of stroke or chronic renal failure. The incidence and the number of microbleeds were assessed in the HD and control groups. The findings of microbleeds with T 2 *-weighted gradient-echo MR imaging were compared with those of T 1 -and T 2 -weighted MR imaging in HD patients. The incidence of microbleeds was significantly greater in the HD patients compared with the control patients. T 2 * -weighted gradient-echo imaging revealed a total of 44 microbleeds in 11 HD patients. T 2 -weighted imaging demonstrated 13 of 44 microbleeds as hyperintensity, whereas T 1 -weighted imaging demonstrated 12 lesions as hypointensity. T 2 -and T 1 -weighted imagings did not demonstrate any findings in 31 and 32 lesions, respectively. T 2 * -weighted gradientecho MR imaging is effective to detect microbleeds which may be a predictor of intracerebral hemorrhage in HD patients and should be included in the protocol for the study of cerebrovascular disease, because T 2 -and T 1 -weighted MR imaging recognizes microbleeds as lacunar infarction.

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Deep and brainstem cavernomas: a consecutive 8-year series

Cited by 193 publications

References 20 publications

Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery

Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery

The lateral infratrigeminal transpontine window to deep pontine lesions

High Incidence of Microbleeds in Hemodialysis Patients Detected by T2*-Weighted Gradient-Echo Magnetic Resonance Imaging

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