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Ahead of Print: Surgical Strategies in Treating Brainstem Cavernous Malformations
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BACKGROUND: Optimal therapy of brainstem cavernous malformations (BSCMs) remains controversial, since their biological behavior is unpredictable and surgical removal is challenging.
OBJECTIVE: To analyze our experience with BSCMs and conduct a review of the literature in an attempt to identify a rational approach to the management of these lesions.
METHODS: Fifty-five patients harboring 57 BSCMs underwent surgery and 17 patients were treated conservatively during a 10-year period from 1999 to 2008. The operative strategy was to perform complete CM resection and to preserve any associated venous malformation, with minimal functional brainstem tissue sacrificed. The National Institute of Health Strength Scale (NIHSS) was used to assess neurological status.
RESULTS: The averaged hemorrhagic and rehemorrhagic rate was 4.7% and 32.7% per patient-year, respectively. For the operated patients, total lesional resection was achieved in all. Their mean NIHSS score was 4.6 after the first episode, 3.5 preoperatively, 3.2 at discharge, and 1.4 after a mean follow-up of 49 months. Complete recovery of motor deficits and sensory disturbances from the preoperative state were 70.4% and 51.7%, respectively. Complete recovery for CN3, CN5, CN6, CN7, and the lower group were 60%, 63.2%, 25%, 57.1%, and 80%, respectively. For the conservative patients, the mean NIHSS score was 5.9 after the first episode and 1.7 after a mean follow-up of 40 months.
CONCLUSION: NIHSS is optimal to evaluate the natural history and surgical effect of patients harboring BSCMs. Surgical resection remains the primary therapeutic option after careful patient screening and preoperative planning.
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