Surgical management of brain stem cavernous malformation

Abstract

Objective The aims of this study were to determine how to choose the appropriate surgical approach based on the anatomical character of the Brain Stem cavernous malformation and to investigate the corresponding surgical skill.Methods The records of 53 adults who presented with Brain Stem cavernous malformation between 20011.3 and 2012.9 were retrospectively reviewed.These lesions were classified according to their anatomical location as follows:ventral midbrain (1 case),lateral midbrain (7 cases),dorsal midbrain (2 cases),lateral pons (28 cases),dorsal pons (4 cases),lateral medulla (2 cases) and dorsal medulla (9 case).All the patients underwent surgical removal of Brain Stem cavernous malformations.The surgical approaches used were orbitozygomatic (1 case),poppen approach (2 cases),subtemporal-transtentorial (27 cases),subtemporal/anterior petrosectomy (6 cases),suboccipital-retrosigmoid (2 cases),midline suboccipital (13 cases) and far-lateral (2 cases).Results Total resection of the Brain Stem cavernous malformation was achieved in all cases (100％).Postoperative improvement was achieved in 18 cases (34％),unchange in 28 (53％).New postoperative deficits were observed in 7 patients (13％).Conclusions The correct surgical approach,skill and assistive technology are the key points to gain good results for the patients with brain stem cavernous malformations. Key words: Brain stem; Cavernous malformation; Microsurgery