The Clinical Preliminary Treatment Experience Of Brainstem Cavernous Malformations

ObjectivesTo investigate the BSCM natural history ,clinical manifestation,and the choice of treatment and summarize the operation experience.MethodsRetrospectively analyzed the BSCM patients datas from March 2008 to April 2017 in No.2 Department of Neurosurgery,The first Affilicated Hospital of Kunming Medical Univisity who were diagnosed by Imageological examination.All patients divided in two parts: surgery and conservative treatment groups according to whether accepted operation. Take the national institutes of health stroke scale(NIHSS) scores to them who have been accepted operation when they admitted and the last follow-up.Then compare the two NIHSS scores and analyze whether there has a statistically significant that neurological function improved by surgical intervention.Both of the two groups were taken the Karnofsky(KPS) scores at the last follow-up,we define the KPS score > 60 points for better prognosis and in total the two groups respectively ,then compare whether there is a statistically significant that the treatment choice for prognosis.After discharge ,counter both the operation group and the conservative treatment group who have the indication but not accepted operation,compare the rebleeding events for the proportion of each group to analyze the operation to reduce the incidence of postoperative rebleeding events whether there has a statistically significant.ResultsThere is 34 patients have been treated in total in the past 9 years. 11 patients accepted operation,the others were followed for conservative(including 13 cases which have the indication but not accepted operation ).The hemorrhage rate was 3.0%for 34 cases、rebleeding events rate was 52.9%.Most clinical manifestions are cranial nerve dysfunction,physical movement disorders.Nine patients with Sub-occipital medline approach,two patients were taken Suboccipital retrosigmoid approach and Cerebellar tonsillar approach.Timing of surgery:subacute stage(8 cases), I case of emergency,chronic phase(2 cases).The gross resection were 10 cases, 1 case of children died from non-surgical related complications,an average follow-up of 30.5 momths,There was no rebleeding events and recurrent lesions,NIHSS score before operation and the last follow-up comparison(P<0.05,neurologic injury have not been appeared).Conservative treatment group average follow-up of 42.1 momths,9 cases have experienced rebleeding events(included 5 cases which have the indication but not accepted operation ) ,KPS >60 points were 17 cases. <60 points were 6 cases (1 cases died) in the last follow-up, KPS >60 points were 10 cases in the surgery group in the last follow-up.Two groups of the last follow-up KPS >60 points patients(P >0.05,no difference between thestatistics ). After discharge ,counter both the operation group and the conservative treatment group who have the indication but not accepted operation,the comparison of rebleeding events(P < 0.05 , the difference was statistically significant).Conclusions1. The indication for surgery in pons:the exogenous lesion type(lesion near the pia mater,less than 2mm);Multiple hemorrhage、Multiple or progress of nerve function defect;The critical condition to life-threatening emergency surgical decompression to save patients life;No effect through the perioperative patients with serious basic diseases.Suggestions on hematoma subacute stage surgery,postoperative effect is satisfactory.Children need to strict the operation indication.2.Surgery in patients with postoperative neurologic status has no obvious increase.3.Gross resect the lesions could reduce the incidence of rebleeding events.4.1n pons oblongata dorsal CM safe resection could crack through the medulla oblongata.