Neurosurgical considerations on highly eloquent brainstem cavernomas during pregnancy

Burkhardt, Jan Karl; Bozinov, Oliver; Nürnberg, Johannes; Shin, Benjamin J.; Woernle, Christoph M.; Ulrich, Nils H.; Bertalanffy, Helmut

doi:10.1016/j.clineuro.2012.02.040

Cited by 15 publications

(14 citation statements)

References 25 publications

(28 reference statements)

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“…[2] However, the incidence of hemorrhage in pregnancy with CCM was higher after receiving cesarean delivery or painless delivery at a gestational age of 32 + weeks (fetal weight >2 kg). [3] Therefore, interdepartmental cooperation is needed to select the delivery mode and decide whether neurosurgical procedures are needed to ensure the safety of pregnant women and the fetus. In this case, the patient showed seizure twice and was highly suspected with cavernous hemangioma after MRI and consultation.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Combined with Epilepsy and Cerebral Cavernous Malformation

Liu

Song

et al. 2017

Chinese Medical Journal

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Section: Discussionmentioning

confidence: 99%

Pregnancy Combined with Epilepsy and Cerebral Cavernous Malformation

Liu

Song

et al. 2017

Chinese Medical Journal

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“…40,43,45 Indication and timing of surgery according to the available literature surgical resection can be considered in all patients with symptomatic lesions. 4,10,25,21,14,46,47 operative risks in this highly eloquent tissue need to be fully disclosed to the patient and patients should be referred to a neurosurgical department with great expertise on the field of SCM. 21,46,47 surgical extirpation of the lesion can be considered for progressively enlarging lesions or in cases of recurrent hemorrhages.…”

confidence: 99%

“…4,10,25,21,14,46,47 operative risks in this highly eloquent tissue need to be fully disclosed to the patient and patients should be referred to a neurosurgical department with great expertise on the field of SCM. 21,46,47 surgical extirpation of the lesion can be considered for progressively enlarging lesions or in cases of recurrent hemorrhages. In young patients with mild symptoms final treatment decision is difficult.…”

confidence: 99%

“…The natural history of scM is mainly unknown due to the relatively small number of conservatively managed patients reported in the literature. among all published studies, only in 10% of the patients with scM treatment was conservative management by observation, 4,46 reflecting the general practice among neurosurgeons of resecting scM when patients are symptomatic. according to the literature in asymptomatic patients follow-up should be performed, while in otherwise healthy, symptomatic patients surgery is generally safe and recommended.…”

Section: Conservative Managementmentioning

confidence: 99%

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The current management of spinal cord cavernoma

et al. 2018

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BACKGROUND Spinal cavernous malformations (SCM) were once thought to be rare lesions of the spinal cord. However, with the broad use of modern imaging techniques the incidence of SCM has significantly increased over the last decades. Management of both symptomatic and incidental findings is therefore of growing importance. However, experience with treatment and follow-up is very limited. METHODS We performed a single institution retrospective review of consecutive patients with SCM treated at our Department between 2006-2016 and discuss the clinical features as well as surgical versus conservative outcomes. We further provide a systematic literature search and discuss the best management of SCM, analyzing recent publications on SCM imaging techniques, surgical approaches and natural history. RESULTS From a total number of 406 consecutive patients with cavernous malformations (CM) treated at our Department between 2006-2016, 29 (7.1 %) were found to be affected by SCM. The localization was cervical in 10 (34.5 %), cervicothoracic in 3 (10.4 %) and thoracic in 16 (55.2 %) patients. In 90 % of patients (n = 26) the diagnosis was made after onset of clinical symptoms. Conservative management was performed for 8 patients, whereas 21 patients underwent surgical removal of the lesion via a posterior approach using (hemi-) laminectomy or laminoplasty. Functional status improved in 15 patients (62. 5%) and remained unchanged in 6 patients (28.5 %) in the operative group, whereas 2 patients (25 %) improved and 6 patients (75 %) remained unchanged in the conservative group during long-term follow-up. CONCLUSIONS Gross-total resection is the only definitive treatment option for symptomatic SCM. Surgical extirpation of the symptomatic SCM lesion through an unilateral laminectomy ( = hemilaminectomy) approach within 3 months of presentation seems to be good treatment option with an acceptable risk of complications and good long-term outcomes. Conservative treatment should be performed in asymptomatic patients and seems to be an option as well in elderly patients and if patients' symptoms at diagnosis are mild and do not show progression over time.

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“…Helmut Bertalanffy had trained in Freiburg (Germany) and Tokyo (Japan) before he was Vice Chair of Neurosurgery in Aachen (Germany) and Chair of Neurosurgery in Marburg (Germany) from 1997 to 2007. Between 2007 and 2010, the USZ Department of Neurosurgery was headed by Helmut Bertalanffy, who is well known for his contributions to modern skull base surgery, and surgery on brain stem cavernomas in particular [ 12 , 17 ].…”

Section: Usz Neurosurgery Under the Direction Of Helmut Bertalanffy (mentioning

confidence: 99%

UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

et al. 2017

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BackgroundThe predecessor of today’s Department of Neurosurgery, UniversitätsSpital Zürich (USZ), was founded 80 years ago as the first independent Swiss clinic dedicated to neurosurgical patient care. On the occasion of this anniversary, we aimed to highlight the history of neurosurgery as a specialty at the USZ, and to put it into the historical context of Swiss and European Neurosurgery.MethodA literature review was conducted and we searched the archives of the USZ and the city of Zurich, as well as those of Swiss journals to extract relevant published articles, books, historical reports and pictures. The USZ Department of Medical History, the Museum of Medical History and the Swiss National Library were contacted to provide source material. To further verify the content, (emeritus) faculty from the USZ and external experts on the history of Swiss neurosurgery reviewed the manuscript.ResultsSurgeries of the head and spine had occasionally been conducted in Zurich by the general surgeons, Rudolf Ulrich Krönlein and Paul Clairmont, before an independent neurosurgical clinic was founded by Hugo Krayenbühl on 6 July 1937. This was the first Swiss department dedicated to neurosurgical patient care. Besides providing high-quality medicine for both the local and wider population, the department was chaired by eminent leaders of neurosurgery, who influenced the scientific and clinical neurosurgery of their time. As such, it has long been regarded as one of the top teaching and research hospitals in Switzerland and in Europe.ConclusionsOn the occasion of its 80th anniversary, we have performed an in-depth review of its development, successes and challenges, with a special focus on the early decades. Reflecting on the past, we have identified common denominators of success in neurosurgery that remain valid today.Electronic supplementary materialThe online version of this article (10.1007/s00701-017-3357-z) contains supplementary material, which is available to authorised users.

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Neurosurgical considerations on highly eloquent brainstem cavernomas during pregnancy

Cited by 15 publications

References 25 publications

Pregnancy Combined with Epilepsy and Cerebral Cavernous Malformation

Pregnancy Combined with Epilepsy and Cerebral Cavernous Malformation

The current management of spinal cord cavernoma

UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

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