Prognosis Analysis Of Microsurgery Treatment For Brainstem Cavernous Malformations And Analysis Of The Complications Of Neurosurgical Procedures Performed In Sitting Position

Objective: To investigate the surgical approaches,curative effects and prognosis of microsurgical treatment for brainstem cavernous malformations(BSCMs)and analyze the perioperative complications of neurosurgical procedures in sitting position.Materials and Methods: The clinic data of 20 patients with BSCMs undergoing microsurgical treatment were analyzed retrospectively,from October,2011 to December,2015.Of 20 patients,12 were situated in pons,5 in mesencephalon,2 in medulla oblongata and 1 in pontomedullary junction.Suboccipital transcerebellar-medullary fissure and the fourth ventricle approach,retrosigmoid approach,infratentorial–supracerebellar approach and pterional approach were applied,the first three of which were in sitting position.CT and MRI examinations were performed before and after the operation in all the patients,in whom the pathological examination was performed after the operation.362 patients undergoing neurosurgical procedures in sitting position,with clinical data were collected,were in the same period.Instances of VAE,subdural hemorrhage and pneumocephalus were analyzed.Results: Total resection of BSCMs was achieved in 18 and subtotal in 2.Neurosurgical statuses were improved in 17 and unchanged in 3.Two patients,who received subtotal resection,recurred during the follow-up period and received second operation.No death occurred in these cases.In a series of 362 procedures,the overall complication rate related to the sitting position was 3.6%,including VAE,tension pneumocephalus and subdural hemorrhage.Every complication rate of different procedures was below 5%.Conclusions: The surgical approach should be chosen according to the imaging examination and the experiences of surgeons.Sitting position can be applied during the surgery in most of patients with BSCMs.Microsurgery is an effective method to treat BSCMs and good prognoses may be obtained by total resection of the tumors in the patients with BSCMs.The complication rate of neurosurgical procedures performed in the sitting position was low.The sitting position provided one of the safe surgical accesses,with appropriate anesthesia techniques.