Surgical outcome and technical issues in symptomatic brainstem cavernous malformations

Abstract

IntroductionSafe entry zone for brain stem surgery has already been established. Selective approaches or routes can be used according to anatomical locations. Appropriate surgical corridors for Brainstem Cavernous Malformations (CM) are critical where neuronavigation is not available. Preoperative GCS, comorbid conditions, and patient's age are strong predictors of the outcome of the surgery. ObjectiveThe study aims to assess the surgical outcome of the brainstem CM. MethodA total of eight patients were observed retrospectively from 2013 to 2017 in a private hospital in Dhaka, Bangladesh, of which the male: female ratio was 3:2. Four patients underwent surgeries, and four patients were treated without surgery. Multiple variables, including preoperative GCS, age of the patient, and comorbid conditions, were analyzed. Operative procedures were analyzed in detail. The patient's symptoms and signs, the timing of surgery, and recurrent hemorrhage were observed. ResultsOut of four (4) surgical patients-1 died due to pneumonia after two months of surgery. One patient developed internuclear ophthalmoplegia immediately after surgery and recovered after two months. 2 patients recovered entirely, of which one developed obstructive hydrocephalus and was managed by endoscopic third ventriculostomy. ConclusionSafety corridors for brainstem CM are to be selected according to the location of the lesions. Preoperative patient status, appropriate patient selection, and perioperative management of the patients are few predictors of surgical outcomes. Making a pseudo plane in removing CM with sharp microdissection is technically helpful even in adhering lesions.