Clinical Features And Microsurgical Treatment Of Cavernous Malformations Located In The Brainstem: Analysis Of 68 Patients

Objectives Microsurgical resection of brainstem cavernous malformations(BSCMs)remains challenging due to their complex anatomic location and vital functions,the purpose of present study was to analyze the clinical features and predictors of neurological outcome in a single-institution series of 68 patients with BSCMs.Patients and Methods The clinical data of 68 consecutive patients with BSCMs underwent microsurgery for symptomatic BSCMs from January 2011 to December 2018 were retrospectively reviewed.The Glasgow Outcome Scale(GOS)at discharge and subsequent follow-up were employed for neurological status assessment.Predictors of the surgical outcomes were analyzed by the univariate and multivariate regression statistics methods.Results The average age of present series was 39.3 years and most patients were female(60.29%,41/68).The vast majority of patients presented as White matter tract deficit(31.61%,49/155)and cranial nerve deficit(25.81%,40/155).The most of patients had one bleeding episode before surgery(60.29%,41/68).The mean size of the lesion was 17.4mm and the most common site of BSCMs was pons(51.47%,35/68).The most of lesions were exophytic or superficial(76.47%,52/68)and laterior location(60.29%,41/68).26 patients had lesions crossed the midline(38.24%,26/68)and 27 patients(39.71%,27/68)had lesions with a concurrent developmental venous anomaly(DVA).The gross total resection rate was 97%(66/68)and the most of patients(52.94%,36/68)underwent surgery during subacute period(3-8 weeks after the last hemorrhage).In postoperative follow up,most patients had preoperative symptoms improvement(60%,93/155)or stability(36.77%,57/155).43 GOS scores(63.24%,43/68)were improved or stable at the mean follow-up of 44 months.In univariate analysis,BSCMs crossed the midline and presented with a DVA were significantly predictors of poor prognosis for BSCMs surgery(p < 0.05).Multivariate analysis of variance suggested that invasion of the midline(p < 0.05,95% CI: 0.003-0.537)and presence of DVA(p < 0.05,95% CI: 0.000-0.070)were independent risk factors for poor prognosis.Conclusions The high incidence of DVA was observed in BSCMs.Satisfactory surgical outcomes were obtained under the premise of detailed assessment of the surgical indications and timing,individualized surgical approach,combined use of DTI and intraoperative electrophysiological monitoring.However,lesions with invasion of the midline and presence of DVA played a vital role in the poor prognosis following surgery for BSCMs.