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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 131-139
DOI: 10.4103/ajns.AJNS_290_17
Original Article

Management and surgical approaches of brainstem cavernous malformations: Our experience and literature review

Delia Cannizzaro
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
4   Department of Neurosurgery, IRCCS Neuromed, Pozzilli IS
,
Giovanni Sabatino
2   Department of Neurosurgery, Catholic University of Rome, Rome
,
Cristina Mancarella
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
4   Department of Neurosurgery, IRCCS Neuromed, Pozzilli IS
,
Martina Revay
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
3   Department of Neurosurgery, University of Milan, Milan
,
Marco Rossi
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
3   Department of Neurosurgery, University of Milan, Milan
,
Guido Pecchioli
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
,
Andrea Cardia
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
,
Giulio Maira
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
,
Vincenzo D'Angelo
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
5   Department of Neurosurgery, “IRCCS Casa Sollievo Della Sofferenza,” San Giovanni Rotondo FG
,
Maurizio Fornari
1   Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano MI, Milan
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Introduction: Brainstem cavernous malformations (BSCMs) are clusters of dilated sinusoidal channels. Clinical presentation is characterized by focal neurological deficits and/or hemorrhage. The goal of this study is to analyze surgical indications and approaches in a series of patients with BSCM and review pertinent literature and suggest prognostic factors related to the anatomical, clinical, and surgical data collected. Methods: We retrospectively reviewed the clinical data of 55 patients with BSCM, treated at three centers, from January 2006 to March 2016. We collected anagraphic data, pre and postoperative neurological status, pre and postradiological images, surgical procedures, and follow-up results. We summarized the anatomical, clinical, and surgical aspects of the lesions and identified two large groups based on the chosen approach: lateral and medial. Clinical and radiological results were then compared. Results: The series comprised 55 patients. Hemorrhagic onset was observed in all patients. Suboccipital, retrosigmoid, anterior, subtentorial, subtemporal, transvermian, telovelar, far lateral and trans, and infratentorial approaches were performed. Neurological status improved postoperatively in 34 cases at last follow-up. Five patients showed clinical neurological worsening. Total resection was achieved in 46 cases and, during a mean follow-up of 63.4 months, no recurrence or re-bleeding occurred in those patients. The mean follow-up was 63.9 months. The mean modified Rankin Scale at final follow-up was used to analyze the results and draw our conclusions. Conclusions: A reasonable surgical approach, selection, and gentle handling of the surrounding structures are required to prevent impairment of neurologic function and avoid partial resection.

Key-words:

Brainstem - cavernous malformation - hemorrhagic events - treatment strategy

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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