Surgical Management Of Brainstem Cavernous Malformation

Objective:Brainstem cavernous malformations are rare low-flow angiographically cryptic vascular malformations. Their surgical treatment remains challenging due to their eloquent location. The authors report surgical experience in a 26 patient series.Method:This retrospective study includes 26 consecutive patients operated on in two medical centers from 2004 to 2014 and analyses of the clinical data, radiological findings, resons for surgical indication, surgical approaches, postoperative courses and longterm outcomes of the patients. Result:There were 14 females and 12 males, the sex ratio was 1.16:1. 18 of the 26 located in the pons( 69.2%), 4 in the medulla oblongata( 15.4%), 4 in the mesencephalon(15.4%), all 26 patients underwent surgery, with different approaches according to the location of the lesion, 11 patients(42.3%) through a trans-fourth ventricle floor approach, 3 patients(11.5%) through a midline suboccipital approach, 6 patients through a retrosigmoid approach(23.1%), 4 patients(15.4%) through a subtemporal approach.1 patient(3.8%) through a fronto-orbito-zygomatic approach. 1 patient(3.8%) through a far lateral approach. In general, 17 patients live a independent working life, 3 patiens lost working ability but live normally, 5 patients need assistance during daily life, 1 patient lived a vegetative state.Conclusion:Brainstem cavernous malformations have a high bleeding and rebleeding rate which may cause severe neurological deficits. Surgical indication includes: 1) progressive neurological deficit due to clinically significant hemorrhagic events 2) pial contact(<2mm) of the cavernous malformation.3) subacute phase in the MRI images. The surgery carries a satisfying outcome, The selection of the patients and the approaches is very important to the surgery.