Surgical treatment of brainstem cavernous malformations with three basic skull base approaches and minimally invasive techniques:Observations in 20 patients

Abstract

Objective Brainstem cavernous malformation (BSCM) is extremely challenging for neurosurgeons in terms of surgical approach choices.In this article, we summarized our experience in skull base approaches of BSCM, and elucidated the advance of surgical treatments of brain stem cavernous malformation through reviewing recent relevant articles. Methods We retrospectively reviewed 20 consecutive patients who underwent resection between May 1, 2014 and April 30, 2016.Only midline suboccipital, subtemporal approach and retrosigmoid approach were used in this series.The diagnoses of all patients were confirmed by radiological and histological examination. Results All 20 patients were completely extirpated without surgical-related mortality.The mean follow-up period was 9.5 months (range, 2-20 months).Of the 20 patients, 80% symptomatic patients underwent surgery after first bleeding episode within 3 months, 20% after two or more bleeding episodes by magnetic resonance imaging.After resection and during follow-up, 75% of patients had an improvement in their modified Rankin scale (mRS) scores, whereas 10% were worse compared with their preoperative presentation; 15% were unchanged. Conclusion Appropriate basic surgical approach and minimally invasive techniques are necessary in preventing impairment of neurologic function.The three common basic skull base approaches, combined with minimally invasive techniques can handle most of BSCMs with good surgical results.