Clinical Analysis of Microsurgery for Brainstem Cavernous Malformations: Surgical Indications, Optimal Approaches, and Clinical Outcomes

Abstract

OBJECTIVE: This study aimed to analyze patients who underwent microsurgery for brainstem cavernous malformations (BCMs) and to investigate the effectiveness and the limitations of surgical resection of BCMs. METHODS: We retrospectively analyzed the clinical data of patients who underwent surgical resections for BCMs between 1989 and 2010. We investigated the age distribution, preoperative hemorrhagic rates, initial clinical presentations, locations of the lesions, and preoperative and postoperative Karnofsky Performance Scale (KPS) scores. We also analyzed surgical indications, the timing of surgery, and surgical approaches. RESULTS: All 15 patients underwent microsurgery for BCMs; 13 underwent total resection of their lesions, but 2 underwent incomplete resections and consequently experienced postoperative recurrent hemorrhage. We observed 11 patients through a complete follow-up, for a mean of 53.1 months (range 1-131 months) after diagnosis (nine patients > 24 months follow-up). During the follow-up periods, 3 patients were lost to follow-up, and one patient expired, due to aspiration pneumonia, 31 months postoperatively. The mean preoperative KPS score was 50, and the mean postoperative KPS score was 67. During the complete follow-up period, 3 patients recovered completely (KPS scores of 90-100) and 7 patients (63.6%) showed improvement in KPS scores. CONCLUSIONS: Surgeons should consider microsurgery for BCMs the treatment of choice for patients who suffer from progressive neurological decline. Successful resection of BCMs depends on an optimal surgical approach, appropriate timing of surgery, and well-informed surgical techniques. The aim of surgery must be total resection of the lesions without any deteriorative neurological morbidity.