Surgical management of brainstem cavernomas

View More View Less
  • 1 Department of Neurosurgery, Nordstadt Hospital; and Department of Neurosurgery, University Medical School, Hannover, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object. A careful retrospective analysis of 36 cases was performed to evaluate the pre- and postoperative rates of morbidity that occur in patients with brainstem cavernous angiomas.

Methods. The authors evaluated immediate postoperative and follow-up outcomes with regard to clinical findings, the incidence of preoperative hemorrhage(s), location and size of the lesions, and the timing of the surgical procedure after the last hemorrhagic event. Specifically, the following parameters were analyzed: 1) number of hemorrhages; 2) the precise brainstem location (pontomesencephalic, pons, and medulla oblongata); 3) pre- and postoperative cranial nerve status; 4) pre- and postoperative motor and sensory deficits; 5) size (volume) of the lesions; and 6) pre- and postoperative Karnofsky Performance Scale (KPS) scores. Multiple hemorrhages were observed in 16 patients, particularly in those with pontomesencephalic cavernous angiomas (75%). The mean preoperative KPS score was 70.3 ± 16.3 (± standard deviation). Twenty-six patients (72.2%) presented with cranial nerve impairment, 13 (36.1%) with motor deficits, and 17 (47.2%) with sensory disturbance. Volume of the lesions ranged from 0.18 to 18.18 cm3 (mean 4.75 cm3). Postoperative complications included new cranial nerve deficits in 17 patients, motor deficits in three, and new sensory disturbances in 12 patients. In a mean follow-up period of 21.5 months, KPS scores were 80 to 100 in 22 patients. Timing of surgery (posthemorrhage) and multiple hemorrhages did not influence the long-term results. Higher preoperative KPS scores and smaller-volume lesions, however, were factors associated with a better final outcome (p < 0.05). Major morbidity was related mainly to preoperative status and less to surgical treatment. The incidence of new postoperative cranial nerve deficits was clearly lower than that demonstrated preoperatively because of the brainstem hemorrhages.

Conclusions. Based on these findings, resection of brainstem cavernomas is the treatment of choice in the majority of these cases because of the high incidence of morbidity related to one or often several brainstem hemorrhages.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Bertalanffy H, , Gilsbach JM, & Eggert HR, et al: Microsurgery of deep-seated cavernous angiomas: report of 26 cases. Acta Neurochir 108:9199, 1991 Bertalanffy H, Gilsbach JM, Eggert HR, et al: Microsurgery of deep-seated cavernous angiomas: report of 26 cases. Acta Neurochir 108:91–99, 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Bien S, , Friedburg H, & Harders A, et al: Intracerebral cavernous angiomas in magnetic resonance imaging. Acta Radiol Suppl 369:7981, 1986 Bien S, Friedburg H, Harders A, et al: Intracerebral cavernous angiomas in magnetic resonance imaging. Acta Radiol Suppl 369:79–81, 1986

    • Search Google Scholar
    • Export Citation
  • 3.

    Biondi A, , Scotti G, & Scialfa G, et al: Magnetic resonance imaging of cerebral cavernous angiomas. Acta Radiol Suppl 369:8285, 1986 Biondi A, Scotti G, Scialfa G, et al: Magnetic resonance imaging of cerebral cavernous angiomas. Acta Radiol Suppl 369:82–85, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Cantore G, , Missori P, & Santoro A: Cavernous angiomas of the brain stem. Intra-axial anatomical pitfalls and surgical strategies. Surg Neurol 52:8494, 1999 Cantore G, Missori P, Santoro A: Cavernous angiomas of the brain stem. Intra-axial anatomical pitfalls and surgical strategies. Surg Neurol 52:84–94, 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Di Rocco C, , Iannelli A, & Tamburrini G: Cavernous angiomas of the brain stem in children. Pediatr Neurosurg 27:9299, 1997 Di Rocco C, Iannelli A, Tamburrini G: Cavernous angiomas of the brain stem in children. Pediatr Neurosurg 27:92–99, 1997

    • Search Google Scholar
    • Export Citation
  • 6.

    Dorsch NWC, & McMahon JHA: Intracranial cavernous malformations—natural history and management. Crit Rev Neurosurg 8:154168, 1998 Dorsch NWC, McMahon JHA: Intracranial cavernous malformations—natural history and management. Crit Rev Neurosurg 8:154–168, 1998

    • Search Google Scholar
    • Export Citation
  • 7.

    Drake CG, , Friedman AH, & Peerless SJ: Posterior fossa arteriovenous malformations. J Neurosurg 64:110, 1986 Drake CG, Friedman AH, Peerless SJ: Posterior fossa arteriovenous malformations. J Neurosurg 64:1–10, 1986

    • Search Google Scholar
    • Export Citation
  • 8.

    Eisner W, , Schmid UD, & Reulen HJ, et al: The mapping and continuous monitoring of the intrinsic motor nuclei during brain stem surgery. Neurosurgery 37:255265, 1995 Eisner W, Schmid UD, Reulen HJ, et al: The mapping and continuous monitoring of the intrinsic motor nuclei during brain stem surgery. Neurosurgery 37:255–265, 1995

    • Search Google Scholar
    • Export Citation
  • 9.

    Fahlbusch R, , Strauss C, & Huk W: Pontine-mesencephalic cavernomas: indications for surgery and operative results. Acta Neurochir Suppl 53:3741, 1991 Fahlbusch R, Strauss C, Huk W: Pontine-mesencephalic cavernomas: indications for surgery and operative results. Acta Neurochir Suppl 53:37–41, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Fahlbusch R, , Strauss C, & Huk W, et al: Surgical removal of pontomesencephalic cavernous hemangiomas. Neurosurgery 26:449457, 1990 Fahlbusch R, Strauss C, Huk W, et al: Surgical removal of pontomesencephalic cavernous hemangiomas. Neurosurgery 26:449–457, 1990

    • Search Google Scholar
    • Export Citation
  • 11.

    Fritschi JA, , Reulen HJ, & Spetzler RF, et al: Cavernous malformations of the brain stem. A review of 139 cases. Acta Neurochir 130:3546, 1994 Fritschi JA, Reulen HJ, Spetzler RF, et al: Cavernous malformations of the brain stem. A review of 139 cases. Acta Neurochir 130:35–46, 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    Heffez DS, , Zinreich SJ, & Long DM: Surgical resection of intrinsic brain stem lesions: an overview. Neurosurgery 27:789798, 1990 Heffez DS, Zinreich SJ, Long DM: Surgical resection of intrinsic brain stem lesions: an overview. Neurosurgery 27:789–798, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Houtteville JP: Brain cavernoma: a dynamic lesion. Surg Neurol 48:610614, 1997 Houtteville JP: Brain cavernoma: a dynamic lesion. Surg Neurol 48:610–614, 1997

    • Search Google Scholar
    • Export Citation
  • 14.

    Huber G, , Piepgras U, & Henkes H, et al: Venenanomalien des Gehirns. Zur klinischen Bedeutung des sogenannten venosen Angioms. Radiologe 31:274282, 1991 Huber G, Piepgras U, Henkes H, et al: Venenanomalien des Gehirns. Zur klinischen Bedeutung des sogenannten venosen Angioms. Radiologe 31:274–282, 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Karlsson B, , Kihlstrom L, & Lindquist C, et al: Radiosurgery for cavernous malformations. J Neurosurg 88:293297, 1998 Karlsson B, Kihlstrom L, Lindquist C, et al: Radiosurgery for cavernous malformations. J Neurosurg 88:293–297, 1998

    • Search Google Scholar
    • Export Citation
  • 16.

    Karnofsky DA, , Burchenal JH, & Armistead GC Jr: Triethylenemelamine in the treatment of neoplastic disease. A compound with nitrogen-mustard-like activity suitable for oral and intravenous use. Arch Intern Med 87:477515, 1951 Karnofsky DA, Burchenal JH, Armistead GC Jr: Triethylenemelamine in the treatment of neoplastic disease. A compound with nitrogen-mustard-like activity suitable for oral and intravenous use. Arch Intern Med 87:477–515, 1951

    • Search Google Scholar
    • Export Citation
  • 17.

    LeDoux MS, , Aronin PA, & Odrezin GT: Surgically treated cavernous angiomas of the brain stem: report of two cases and review of the literature. Surg Neurol 35:395399, 1991 LeDoux MS, Aronin PA, Odrezin GT: Surgically treated cavernous angiomas of the brain stem: report of two cases and review of the literature. Surg Neurol 35:395–399, 1991

    • Search Google Scholar
    • Export Citation
  • 18.

    Lee RR, , Becher MW, & Benson ML, et al: Brain capillary telangiectasia: MR imaging appearance and clinicohistopathologic findings. Radiology 205:797805, 1997 Lee RR, Becher MW, Benson ML, et al: Brain capillary telangiectasia: MR imaging appearance and clinicohistopathologic findings. Radiology 205:797–805, 1997

    • Search Google Scholar
    • Export Citation
  • 19.

    Liscak R, , Vladyka V, & Simonova G, et al: Gamma knife radio-surgery of the brain stem cavernomas. Minim Invasive Neurosurg 43:201207, 2000 Liscak R, Vladyka V, Simonova G, et al: Gamma knife radio-surgery of the brain stem cavernomas. Minim Invasive Neurosurg 43:201–207, 2000

    • Search Google Scholar
    • Export Citation
  • 20.

    Lynch JC, , Andrade R, & Pereira C, et al: Angioma cavernoso intracraniano. Arq Neuropsiquiatr 52:237242, 1994 Lynch JC, Andrade R, Pereira C, et al: Angioma cavernoso intracraniano. Arq Neuropsiquiatr 52:237–242, 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Meixensberger J, , Hofmann E, & Roosen K: Zerebrale Kavernome—Klinik und Therapie. Wien Med Wochenschr 147:194198, 1997 Meixensberger J, Hofmann E, Roosen K: Zerebrale Kavernome—Klinik und Therapie. Wien Med Wochenschr 147:194–198, 1997

    • Search Google Scholar
    • Export Citation
  • 22.

    Mizoi K, , Yoshimoto T, & Suzuki J: Clinical analysis of ten cases with surgically treated brain stem cavernous angiomas. Tohoku J Exp Med 166:259267, 1992 Mizoi K, Yoshimoto T, Suzuki J: Clinical analysis of ten cases with surgically treated brain stem cavernous angiomas. Tohoku J Exp Med 166:259–267, 1992

    • Search Google Scholar
    • Export Citation
  • 23.

    Morcos JJ, , Heros RC, & Frank DE: Microsurgical treatment of infratentorial malformations. Neurosurg Clin N Am 10:441474, 1999 Morcos JJ, Heros RC, Frank DE: Microsurgical treatment of infratentorial malformations. Neurosurg Clin N Am 10:441–474, 1999

    • Search Google Scholar
    • Export Citation
  • 24.

    Moriarity JL, , Clatterbuck RE, & Rigamonti D: The natural history of cavernous malformations. Neurosurg Clin N Am 10:411417, 1999 Moriarity JL, Clatterbuck RE, Rigamonti D: The natural history of cavernous malformations. Neurosurg Clin N Am 10:411–417, 1999

    • Search Google Scholar
    • Export Citation
  • 25.

    Ojemann RG, , Crowell RM, & Ogilvy CS: Surgical management of cavernous angiomas of the nervous system, in Schmidek HH, & Sweet WH (eds): Operative Neurosurgical Techniques. Indication, Methods, and Results, ed 3. Philadelphia: WB Saunders, 1995, Vol 2, pp 11831196 Ojemann RG, Crowell RM, Ogilvy CS: Surgical management of cavernous angiomas of the nervous system, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques. Indication, Methods, and Results, ed 3. Philadelphia: WB Saunders, 1995, Vol 2, pp 1183–1196

    • Search Google Scholar
    • Export Citation
  • 26.

    Pozzati E, , Acciarri N, & Tognetti F, et al: Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery 38:662670, 1996 Pozzati E, Acciarri N, Tognetti F, et al: Growth, subsequent bleeding, and de novo appearance of cerebral cavernous angiomas. Neurosurgery 38:662–670, 1996

    • Search Google Scholar
    • Export Citation
  • 27.

    Raps EC, , Galetta SL, & King JT Jr, et al: Isolated one-and-a-half syndrome with pontine cavernous angioma: successful surgical removal. J Clin Neuroophthalmol 10:287290, 1990 Raps EC, Galetta SL, King JT Jr, et al: Isolated one-and-a-half syndrome with pontine cavernous angioma: successful surgical removal. J Clin Neuroophthalmol 10:287–290, 1990

    • Search Google Scholar
    • Export Citation
  • 28.

    Rigamonti D, , Hadley MN, & Drayer BP, et al: Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319:343347, 1988 Rigamonti D, Hadley MN, Drayer BP, et al: Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319:343–347, 1988

    • Search Google Scholar
    • Export Citation
  • 29.

    Rigamonti D, & Spetzler RF: The association of venous and cavernous malformations. Report of four cases and discussion of the pathophysiological, diagnostic, and therapeutic implications. Acta Neurochir 92:100105, 1988 Rigamonti D, Spetzler RF: The association of venous and cavernous malformations. Report of four cases and discussion of the pathophysiological, diagnostic, and therapeutic implications. Acta Neurochir 92:100–105, 1988

    • Search Google Scholar
    • Export Citation
  • 30.

    Rigamonti D, , Spetzler RF, & Drayer BP, et al: Appearance of venous malformations on magnetic resonance imaging. J Neurosurg 69:535539, 1988 Rigamonti D, Spetzler RF, Drayer BP, et al: Appearance of venous malformations on magnetic resonance imaging. J Neurosurg 69:535–539, 1988

    • Search Google Scholar
    • Export Citation
  • 31.

    Robinson JR, , Awad IA, & Little JR: Natural history of the cavernous angioma. J Neurosurg 75:709714, 1991 Robinson JR, Awad IA, Little JR: Natural history of the cavernous angioma. J Neurosurg 75:709–714, 1991

    • Search Google Scholar
    • Export Citation
  • 32.

    Sakai N, , Sakai H, & Gotoh Y, et al: [Surgical treatment of brain stem lesions with reference to cavernous angioma.] No To Shinkei 44:983988, 1992 (Jpn) Sakai N, Sakai H, Gotoh Y, et al: [Surgical treatment of brain stem lesions with reference to cavernous angioma.] No To Shinkei 44:983–988, 1992 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 33.

    Sass F, , Bouche C, & Leitner A: Flächen und Körperberechnung, in Sass F, , Bouche C, & Leitner A (eds): Dubbels Taschenbuch für den Maschinenbau, ed 12. Berlin: Springer-Verlag, 1966, pp 187188 Sass F, Bouche C, Leitner A: Flächen und Körperberechnung, in Sass F, Bouche C, Leitner A (eds): Dubbels Taschenbuch für den Maschinenbau, ed 12. Berlin: Springer-Verlag, 1966, pp 187–188

    • Search Google Scholar
    • Export Citation
  • 34.

    Simard JM, , Garcia-Bengochea F, & Ballinger WE Jr, et al: Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 18:162172, 1986 Simard JM, Garcia-Bengochea F, Ballinger WE Jr, et al: Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery 18:162–172, 1986

    • Search Google Scholar
    • Export Citation
  • 35.

    Stein BM, & Solomon RA: Surgical approaches to posterior fossa arteriovenous malformations. Clin Neurosurg 37:353371, 1991 Stein BM, Solomon RA: Surgical approaches to posterior fossa arteriovenous malformations. Clin Neurosurg 37:353–371, 1991

    • Search Google Scholar
    • Export Citation
  • 36.

    Steinberg GK, , Chang SD, & Gewirtz RJ, et al: Microsurgical resection of brainstem, thalamic, and basal ganglia angiographically occult vascular malformations. Neurosurgery 46:260271, 2000 Steinberg GK, Chang SD, Gewirtz RJ, et al: Microsurgical resection of brainstem, thalamic, and basal ganglia angiographically occult vascular malformations. Neurosurgery 46:260–271, 2000

    • Search Google Scholar
    • Export Citation
  • 37.

    Strauss C, & Fahlbusch R: Anatomical aspects for surgery within the floor of the IVth ventricle. Zentralbl Neurochir 58:712, 1997 Strauss C, Fahlbusch R: Anatomical aspects for surgery within the floor of the IVth ventricle. Zentralbl Neurochir 58:7–12, 1997

    • Search Google Scholar
    • Export Citation
  • 38.

    Strauss C, , Romstock J, & Nimsky C, et al: Intraoperative identification of motor areas of the rhomboid fossa using direct stimulation. J Neurosurg 79:393399, 1993 Strauss C, Romstock J, Nimsky C, et al: Intraoperative identification of motor areas of the rhomboid fossa using direct stimulation. J Neurosurg 79:393–399, 1993

    • Search Google Scholar
    • Export Citation
  • 39.

    Symon L, , Jackowski A, & Bills D: Surgical treatment of pontomedullary cavernomas. Br J Neurosurg 5:339347, 1991 Symon L, Jackowski A, Bills D: Surgical treatment of pontomedullary cavernomas. Br J Neurosurg 5:339–347, 1991

    • Search Google Scholar
    • Export Citation
  • 40.

    Weil SM, & Tew JM Jr: Surgical management of brain stem vascular malformations. Acta Neurochir 105:1423, 1990 Weil SM, Tew JM Jr: Surgical management of brain stem vascular malformations. Acta Neurochir 105:14–23, 1990

    • Search Google Scholar
    • Export Citation
  • 41.

    Wowra B, , Layer G, & Schad LR, et al: Three-dimensional time-of-flight MR-angiography and the surgical indication of brainstem cavernomas. Acta Neurochir 112:7782, 1991 Wowra B, Layer G, Schad LR, et al: Three-dimensional time-of-flight MR-angiography and the surgical indication of brainstem cavernomas. Acta Neurochir 112:77–82, 1991

    • Search Google Scholar
    • Export Citation
  • 42.

    Yoshimoto T, & Suzuki J: Radical surgery on cavernous angioma of the brainstem. Surg Neurol 26:7278, 1986 Yoshimoto T, Suzuki J: Radical surgery on cavernous angioma of the brainstem. Surg Neurol 26:72–78, 1986

    • Search Google Scholar
    • Export Citation
  • 43.

    Zabramski JM, , Wascher TM, & Spetzler RF, et al: The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 80:422432, 1994 Zabramski JM, Wascher TM, Spetzler RF, et al: The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 80:422–432, 1994

    • Search Google Scholar
    • Export Citation
  • 44.

    Zimmerman RS, , Spetzler RF, & Lee KS, et al: Cavernous malformations of the brain stem. J Neurosurg 75:3239, 1991 Zimmerman RS, Spetzler RF, Lee KS, et al: Cavernous malformations of the brain stem. J Neurosurg 75:32–39, 1991

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1512 322 27
Full Text Views 450 43 12
PDF Downloads 217 24 5
EPUB Downloads 0 0 0