Management and Surgical Outcomes of Brain Stem Cavernomas: A Nine-Year Retrospective Analysis of 20 Cases
Journal of Otorhinolaryngology and Facial Plastic Surgery,
Vol. 9 No. 1 (2023),
2 September 2023
,
Page 1-9
https://doi.org/10.22037/orlfps.v9i1.47016
Abstract
Background: Brain stem cavernomas (BSCs) are rare vascular malformations, accounting for 8-22% of intracranial cavernoma lesions. These lesions can cause severe neurological deficits and life-threatening hemorrhages, making their management challenging.
Aimes: This study retrospectively evaluates the clinical presentation, surgical management, and outcomes of patients with BSCs to improve clinical strategies and patient care.
Methods: This retrospective study analyzed 20 patients with BSCs treated at Loghman Hakim Hospital, Tehran, Iran, from 2014 to 2023. Clinical data were collected from medical records, including demographic information, clinical presentations, imaging findings, and surgical intervention details. Lesion characteristics were documented and classified. Surgical approaches were based on lesion location and proximity to critical structures. Outcomes were assessed using the Modified Rankin Scale (MRS), resolution of cranial nerve (CN) palsies, incidence of rebleeding, and postoperative complications. Descriptive statistics was used to summarize patient characteristics and outcomes.
Results: The study included 20 patients (mean age 34.25 years; 55% male) with a mean follow-up of 37.1 months. The most common presentation was headache (30%), followed by hemiparesis (15%) and cerebellar symptoms (70%). Prior hemorrhage occurred in 75% of cases. Lesions were predominantly deep-seated (60%) and averaged 30 mm in diameter. Postoperative outcomes showed improvement in MRS scores in 75% of cases, with CN palsies resolving in 20%. Rebleeding occurred in 20% of patients, and other complications included ataxia and gait disturbances. Surgical management, primarily through suboccipital telovelar and retrosigmoid approaches, significantly improved neurological function and quality of life.
Conclusion: Surgical intervention for symptomatic BSCs, particularly through suboccipital telovelar and retrosigmoid approaches, leads to favorable clinical outcomes. Accurate patient selection, preoperative planning, and meticulous microsurgical techniques are crucial for optimizing results. Future research should focus on refining surgical approaches and exploring genetic and molecular aspects of BSCs to enhance management strategies and patient outcomes.
- Brain stem cavernomas; Surgical management; Clinical strategies; Patient care.
How to Cite
References
Brunon J, Nuti C. [Natural history of cavernomas of the central nervous system]. Neurochirurgie. 2007;53(2-3 Pt 2):122-130. doi:10.1016/j.neuchi.2007.02.006
Houtteville JP. Brain cavernoma: a dynamic lesion. Surg Neurol. 1997;48(6):610-614. doi:10.1016/s0090-3019(96)00551-4
Labauge P. [Familial forms of central nervous system cavernomas: from recognition to gene therapy]. Neurochirurgie. 2007;53(2-3 Pt 2):152-155. doi:10.1016/j.neuchi.2007.02.007
Dorsch NWC, McMahon JHA. Intracranial cavernous malformations - natural history and management. Crit Rev Neurosurg. 1998;8(3):154-168. doi:10.1007/s003290050073
Janićijević A, Repac N, Nikolić I, et al. The Clinical Features and Surgical Approaches for BSCs. J Neurol Surg A Cent Eur Neurosurg. 2015;76(S 02):s-0035-1566376. doi:10.1055/s-0035-1566376
Tarnaris A, Fernandes RP, Kitchen ND. Does conservative management for BSCs have better long-term outcome? Br J Neurosurg. 2008;22(6):748-757. doi:10.1080/02688690802354210
Bertalanffy H, Benes L, Miyazawa T, Alberti O, Siegel AM, Sure U. Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients. Neurosurg Rev. 2002;25(1-2):1-53; discussion 54-55. doi:10.1007/s101430100179
Requena I, Arias M, López-Ibor L, et al. Cavernomas of the central nervous system: clinical and neuroimaging manifestations in 47 patients. J Neurol Neurosurg Psychiatry. 1991;54(7):590-594. doi:10.1136/jnnp.54.7.590
Hauck EF, Barnett SL, White JA, Samson D. Symptomatic BSCs. Neurosurgery. 2009;64(1):61-70; discussion 70-71. doi:10.1227/01.NEU.0000335158.11692.53
Dumas G, Schmerber S. [Cavernous haemangiomas: hearing and vestibular inaugural symptoms]. Ann Otolaryngol Chir Cervicofac. 2004;121(5):272-281. doi:10.1016/s0003-438x(04)95520-x
Sahoo T, Johnson EW, Thomas JW, et al. Mutations in the gene encoding KRIT1, a Krev-1/rap1a binding protein, cause cerebral cavernous malformations (CCM1). Hum Mol Genet. 1999;8(12):2325-2333. doi:10.1093/hmg/8.12.2325
Bravi L, Malinverno M, Pisati F, et al. Endothelial Cells Lining Sporadic Cerebral Cavernous Malformation Cavernomas Undergo Endothelial-to-Mesenchymal Transition. Stroke. 2016;47(3):886-890. doi:10.1161/STROKEAHA.115.011867
Fotakopoulos G, Kivelev J, Andrade-Barazarte H, Tjahjadi M, Goehre F, Hernesniemi J. Outcome in Patients with Spinal Cavernomas Presenting with Symptoms Due to Mass Effect and/or Hemorrhage: Conservative versus Surgical Management: Meta-analysis of Direct Comparison of Approach-Related Complications. World Neurosurg. 2021;152:6-18. doi:10.1016/j.wneu.2021.05.094
Pechstein U, Zentner J, Van Roost D, Schramm J. Surgical management of brain-stem cavernomas. Neurosurg Rev. 1997;20(2):87-93. doi:10.1007/BF01138189
Hong I, Kim KH, Oh HJ, et al. The surgical outcomes and nuances of the telovelar approach for pontine and medullary cavernous malformations: A multi-institutional case series. Journal of Korean Skull Base Society. 2023;18(2):75-84.
Abla AA, Turner JD, Mitha AP, Lekovic G, Spetzler RF. Surgical approaches to brainstem cavernous malformations. Neurosurg Focus. 2010;29(3):E8. doi:10.3171/2010.6.FOCUS10128
Wang Z, Qian C, Shi L, Wang L, Zhang J, Wang Y. Surgery Approaches to Brainstem Cavernous Malformations. J Craniofac Surg. 2015;26(7):e577-580. doi:10.1097/SCS.0000000000002128
Sarma S, Sekhar LN. BSCs excised by subtemporal-infratemporal approach. Br J Neurosurg. 2002;16(2):172-177. doi:10.1080/02688690220131831
Salunke P, Sahoo S, Futane S. Successful excision of a pontomesencephalic cavernoma through anterior subtemporal route without mapping: Anatomical landmarks as a road map. Surg Neurol Int. 2014;5:15. doi:10.4103/2152-7806.126044
Ziyal IM, Sekhar LN, Salas E. Subtonsillar-transcerebellomedullary approach to lesions involving the fourth ventricle, the cerebellomedullary fissure and the lateral brainstem. Br J Neurosurg. 1999;13(3):276-284. doi:10.1080/02688699943682
Hwang SW, Heilman CB, Riesenburger RI, Kryzanski J. C1-C2 arthrodesis after transoral odontoidectomy and suboccipital craniectomy for ventral brain stem compression in Chiari I patients. Eur Spine J. 2008;17(9):1211-1217. doi:10.1007/s00586-008-0706-x
Kivelev J, Niemelä M, Hernesniemi J. Treatment strategies in cavernomas of the brain and spine. J Clin Neurosci. 2012;19(4):491-497. doi:10.1016/j.jocn.2011.08.015
Rodríguez R, Molet J, de Teresa S, et al. [Intraoperative neurophysiological monitoring of brain stem in a case of cavernoma in the pons]. Neurocirugia (Astur). 2005;16(2):117-123.
- Abstract Viewed: 115 times
- PDF Downloaded: 99 times