Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2002 Mar;72(3):351–355. doi: 10.1136/jnnp.72.3.351

Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results

I Sandalcioglu 1, H Wiedemayer 1, S Secer 1, S Asgari 1, D Stolke 1
PMCID: PMC1737795  PMID: 11861694

Abstract

Objectives: This study was undertaken to review the indications for surgical treatment of brain stem cavernomas and to develop strategies to minimise the complications of surgery.

Patients and results: Twelve patients underwent surgical resection of a brain stem cavernoma due to symptoms caused by one or more haemorrhages. Age ranged from 18 to 47 years (mean 29.2 years). Long term follow up (mean 3.7 years) included a complete neurological examination and annual MRI studies. The annual haemorrhage rate was 6.8 %/patient/year and a rate of 1.9 rehaemorrhages/patient/year was found. Surgery was performed under microsurgical conditions with endoscopic assistance, use of neuronavigation, and neurophysiological monitoring. Navigation proved to be reliable when applied in an early stage of operative procedure with minimal brain retraction. Endoscopy was a useful tool in some cases to confirm complete resection of the lesion and to ascertain haemostasis. Ten patients had a new neurological deficit in the early postoperative period, nine of these were transient. At the last follow up the neurological state was improved in five patients, unchanged in six, and worse in one compared with the preoperative conditions. The preoperative average Rankin score was 2.2 points and had improved at the last follow up by 0.6 points to 1.6 points.

Conclusions: Symptomatic brain stem cavernomas should be considered for surgical treatment after the first bleeding. Careful selection of the optimal operative approach and a meticulous microsurgical technique are mandatory. The additional use of modern tools such as neuronavigation, endoscopic assistance, and monitoring can contribute to the safety of the procedure.

Full Text

The Full Text of this article is available as a PDF (207.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aiba T., Tanaka R., Koike T., Kameyama S., Takeda N., Komata T. Natural history of intracranial cavernous malformations. J Neurosurg. 1995 Jul;83(1):56–59. doi: 10.3171/jns.1995.83.1.0056. [DOI] [PubMed] [Google Scholar]
  2. Bellotti C., Medina M., Oliveri G., Barrale S., Ettorre F. Cystic cavernous angiomas of the posterior fossa. Report of three cases. J Neurosurg. 1985 Nov;63(5):797–799. doi: 10.3171/jns.1985.63.5.0797. [DOI] [PubMed] [Google Scholar]
  3. Bertalanffy H., Gilsbach J. M., Eggert H. R., Seeger W. Microsurgery of deep-seated cavernous angiomas: report of 26 cases. Acta Neurochir (Wien) 1991;108(3-4):91–99. doi: 10.1007/BF01418515. [DOI] [PubMed] [Google Scholar]
  4. Fahlbusch R., Strauss C., Huk W., Röckelein G., Kömpf D., Ruprecht K. W. Surgical removal of pontomesencephalic cavernous hemangiomas. Neurosurgery. 1990 Mar;26(3):449–457. doi: 10.1097/00006123-199003000-00012. [DOI] [PubMed] [Google Scholar]
  5. Fritschi J. A., Reulen H. J., Spetzler R. F., Zabramski J. M. Cavernous malformations of the brain stem. A review of 139 cases. Acta Neurochir (Wien) 1994;130(1-4):35–46. doi: 10.1007/BF01405501. [DOI] [PubMed] [Google Scholar]
  6. Kashiwagi S., van Loveren H. R., Tew J. M., Jr, Wiot J. G., Weil S. M., Lukin R. A. Diagnosis and treatment of vascular brain-stem malformations. J Neurosurg. 1990 Jan;72(1):27–34. doi: 10.3171/jns.1990.72.1.0027. [DOI] [PubMed] [Google Scholar]
  7. Kondziolka D., Lunsford L. D., Kestle J. R. The natural history of cerebral cavernous malformations. J Neurosurg. 1995 Nov;83(5):820–824. doi: 10.3171/jns.1995.83.5.0820. [DOI] [PubMed] [Google Scholar]
  8. LeDoux M. S., Aronin P. A., Odrezin G. T. Surgically treated cavernous angiomas of the brain stem: report of two cases and review of the literature. Surg Neurol. 1991 May;35(5):395–399. doi: 10.1016/0090-3019(91)90053-c. [DOI] [PubMed] [Google Scholar]
  9. Ondra S. L., Doty J. R., Mahla M. E., George E. D. Surgical excision of a cavernous hemangioma of the rostral brain stem: case report. Neurosurgery. 1988 Oct;23(4):490–493. doi: 10.1227/00006123-198810000-00015. [DOI] [PubMed] [Google Scholar]
  10. Otten P., Pizzolato G. P., Rilliet B., Berney J. A propos de 131 cas d'angiomes caverneux (cavernomes) du s.n.c., repérés par l'analyse rétrospective de 24 535 autopsies. Neurochirurgie. 1989;35(2):82-3, 128-31. [PubMed] [Google Scholar]
  11. Porter R. W., Detwiler P. W., Spetzler R. F., Lawton M. T., Baskin J. J., Derksen P. T., Zabramski J. M. Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg. 1999 Jan;90(1):50–58. doi: 10.3171/jns.1999.90.1.0050. [DOI] [PubMed] [Google Scholar]
  12. Rigamonti D., Drayer B. P., Johnson P. C., Hadley M. N., Zabramski J., Spetzler R. F. The MRI appearance of cavernous malformations (angiomas). J Neurosurg. 1987 Oct;67(4):518–524. doi: 10.3171/jns.1987.67.4.0518. [DOI] [PubMed] [Google Scholar]
  13. Rutka J. T., Brant-Zawadzki M., Wilson C. B., Rosenblum M. L. Familial cavernous malformations. Diagnostic potential of magnetic resonance imaging. Surg Neurol. 1988 Jun;29(6):467–474. doi: 10.1016/0090-3019(88)90142-5. [DOI] [PubMed] [Google Scholar]
  14. Sakai N., Yamada H., Tanigawara T., Asano Y., Andoh T., Tanabe Y., Takada M. Surgical treatment of cavernous angioma involving the brainstem and review of the literature. Acta Neurochir (Wien) 1991;113(3-4):138–143. doi: 10.1007/BF01403199. [DOI] [PubMed] [Google Scholar]
  15. Sarwar M., McCormick W. F. Intracerebral venous angioma. Case report and review. Arch Neurol. 1978 May;35(5):323–325. doi: 10.1001/archneur.1978.00500290069012. [DOI] [PubMed] [Google Scholar]
  16. Seifert V., Gaab M. R. Laser-assisted microsurgical extirpation of a brain stem cavernoma: case report. Neurosurgery. 1989 Dec;25(6):986–990. doi: 10.1097/00006123-198912000-00025. [DOI] [PubMed] [Google Scholar]
  17. Sindou M., Yada J., Salord F. Functional results after microsurgical resection of brain stem cavernous malformations (retrospective study of a 12 patient series and review of the recent literature). Acta Neurochir (Wien) 2000;142(8):843–853. doi: 10.1007/s007010070069. [DOI] [PubMed] [Google Scholar]
  18. Voigt K., Yaşargil M. G. Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia (Stuttg) 1976 Mar;19(2):59–68. doi: 10.1055/s-0028-1090391. [DOI] [PubMed] [Google Scholar]
  19. Yoshimoto T., Suzuki J. Radical surgery on cavernous angioma of the brainstem. Surg Neurol. 1986 Jul;26(1):72–78. doi: 10.1016/0090-3019(86)90067-4. [DOI] [PubMed] [Google Scholar]
  20. Ziyal I. M., Sekhar L. N., Salas E., Sen C. Surgical management of cavernous malformations of the brain stem. Br J Neurosurg. 1999 Aug;13(4):366–375. doi: 10.1080/02688699943466. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES