Microroll Retractor for Surgical Resection of Brainstem Cavernomas

Ichinose, Tsutomu; Goto, Takeo; Morisako, Hiroki; Takami, Toshihiro; Ohata, Kenji

doi:10.1016/j.wneu.2010.06.049

Cited by 26 publications

(17 citation statements)

References 12 publications

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“…Commonly they are found in the brain, supratentorial being more frequent than infratentorial (80% vs. 20%). Most reports about posterior fossa CMs are brainstem ones, which generally present with significant focal neurological deficits (15,17,35,37,40,41). The cerebellar CMs are rarely reported, perhaps because surgery is usually safe and successful.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases

Wang

et al. 2015

World Neurosurgery

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Section: Discussionmentioning

confidence: 99%

“…Patients who undergo early hematoma evacuation may benefit more from relief of a local mass effect and symptom alleviation than from actual lesion removal (3,5,7,8,11,17,18,36,41). For patients with massive hemorrhage and unstable clinical conditions, an emergency surgery may be necessary.…”

Section: Surgical Managementmentioning

confidence: 99%

Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases

Wang

et al. 2015

World Neurosurgery

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“…Outcomes are not directly comparable between some of the reported studies due to differing surgical indications, surgical approach guidelines, methods for the evaluation of neurological function, and follow-up durations, but our results were generally similar to those of prior series. 3,4,10,14,17,19,24,25,28,32,37,38,45,48,49,53,54,57,59,64,65,69 After a mean followup duration of 89.4 months, the condition of 89.7% of the patients was improved or unchanged, and permanent morbidity was observed in 26.9%. In most cases, surgical morbidity improved and did not have a significant impact on the patients' quality of life; additionally, patients developed coping strategies to live with these deficits.…”

Section: Long-term Outcomementioning

confidence: 99%

“…Based on the 137 cases in our earlier study, we noted that the postoperative annual hemorrhage rate decreased from 0.5% (3 hemorrhages/[129 × 52/12] patient-years) to 0.3% as the followup duration increased, which further verified the effect of surgery on brainstem CMs. Some factors have been related to postoperative hemorrhage, such as incomplete resection 3,4,18,27,32,[36][37][38]52,67,68 and associated DVA. 1,11,15,16,23,34,47,57,58,62,71 In one study, postoperative hemorrhage was observed in 65 (62%) of 105 partially resected brainstem CMs, emphasizing the importance of total removal.…”

Section: Incomplete Resection and Dvamentioning

confidence: 99%

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Yang

Hao

et al. 2013

JNS

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Object The aim of this study was to evaluate the pre- and postoperative rehemorrhage risk, neurological function outcome, and prognostic factors of surgically treated brainstem cavernous malformations (CMs) with long-term follow-up. Methods The authors conducted a retrospective review of the clinical data from 242 patients with brainstem CMs that were surgically treated between 1999 and 2010. Patient charts, imaging findings, and outcomes were examined. Results The study included 242 patients, with a male-to-female ratio of 1.3 and mean age of 32.6 years. The mean modified Rankin Scale scores on admission, at discharge, at 3 and 6 months after surgery, and at recent evaluation were 2.2, 2.6, 2.3, 1.8, and 1.5, respectively. The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0% and 60.9%, respectively. The complete resection rate was 95%. Surgical morbidity occurred in 112 patients (46.3%). Eighty-five patients (35.1%) demonstrated worsened condition immediately after surgery; 34 (41.0%) and 51 (61.4%) of these patients recovered to their baseline level within 3 and 6 months after surgery, respectively. At a mean follow-up of 89.4 months, the patients' condition had improved in 147 cases (60.7%), was unchanged in 70 cases (28.9%), and had worsened in 25 cases (10.3%). A total of 8 hemorrhages occurred in 6 patients, and the postoperative annual hemorrhage rate was 0.4%. Permanent morbidity remained in 65 patients (26.9%). The adverse factors for preoperative rehemorrhage were age ≥ 50 years, size ≥ 2 cm, and perilesional edema. The risk factors for postoperative hemorrhage were developmental venous anomaly and incomplete resection. The independent adverse factors for long-term outcome were increased age, multiple hemorrhages, ventral-seated lesions, and poor preoperative status. Favorable, complete improvement in the postoperative deficits over time was correlated with good preoperative neurological function and continuing improvement thereafter. Conclusions Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates were achieved via surgery. Total resection should be attempted with an aim of minimal injury to neurological function; however, postoperative deficits can improve during the postoperative course. Close follow-up with radiological examination is proposed for patients with adverse factors predictive of rehemorrhage.

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“…3,11,17 Results Incorporating our own results (with 2 cases not published in the literature), we found 65 cases of brainstem CMs resected via a petrosal approach in 20 reports. 1,5,7,12,13,21,25,27,30,32,36,39,40,42,44,46,48,50,51,53 The specific approaches were posterior petrosal in 37 cases (57%), anterior petrosal in 17 (26%), extended posterior petrosal in 10 (15%), and a combined petrosal approach in 1 (2%) ( Table 1). Extended posterior petrosal approaches included the transcrusal approach (partial labyrinthectomy) in 5 cases (8%), petrosal translabyrinthine approach in 4 (6%), and the petrosal transcochlear approach in 1 case (2%).…”

Section: Methodsmentioning

confidence: 99%

Petrosal approaches to brainstem cavernous malformations

Gross

Dunn²,

Du³

et al. 2012

FOC

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Object Although they provide excellent ventral and lateral exposure of the brainstem, petrosal approaches to brainstem cavernous malformations (CMs) are infrequently reported. Methods The authors reviewed their experience with petrosal approaches to brainstem CMs in combination with a comprehensive review of the literature to elucidate resection rates, complication rates, and outcomes. Results Including their own results, the authors found 65 cases in 20 reports of brainstem CMs treated with petrosal approaches. The specific approaches were posterior petrosal in 37 cases (57%), anterior petrosal in 17 (26%), extended posterior petrosal in 10 (15%), and a combined petrosal approach in 1 case (2%). For 50 cases in 16 reports with detailed outcome information, the overall complete resection rate was 90%, with early postoperative morbidity reported in 30% of cases and permanent morbidity in 14%. The rate of CSF leakage was 6%. Conclusions The versatile petrosal approaches to brainstem CMs are associated with good outcomes and an acceptable morbidity rate. More expansive lesions can be approached using a combination of the standard anterior and posterior petrosal approach, preserving hearing and avoiding the greater complication rates associated with extended posterior petrosal approaches.

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Microroll Retractor for Surgical Resection of Brainstem Cavernomas

Cited by 26 publications

References 12 publications

Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases

Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Petrosal approaches to brainstem cavernous malformations

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