Brain stem cavernous malformations

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

“…Outcomes are not directly comparable between some of the reported studies due to differing surgical indications, surgical approach guidelines, methods for the evaluation of neurological function, and follow-up durations, but our results were generally similar to those of prior series. 3,4,10,14,17,19,24,25,28,32,37,38,45,48,49,53,54,57,59,64,65,69 After a mean followup duration of 89.4 months, the condition of 89.7% of the patients was improved or unchanged, and permanent morbidity was observed in 26.9%. In most cases, surgical morbidity improved and did not have a significant impact on the patients' quality of life; additionally, patients developed coping strategies to live with these deficits.…”

“…Based on the 137 cases in our earlier study, we noted that the postoperative annual hemorrhage rate decreased from 0.5% (3 hemorrhages/[129 × 52/12] patient-years) to 0.3% as the followup duration increased, which further verified the effect of surgery on brainstem CMs. Some factors have been related to postoperative hemorrhage, such as incomplete resection 3,4,18,27,32,[36][37][38]52,67,68 and associated DVA. 1,11,15,16,23,34,47,57,58,62,71 In one study, postoperative hemorrhage was observed in 65 (62%) of 105 partially resected brainstem CMs, emphasizing the importance of total removal.…”

“…4,28,57,71,74 It has been suggested that venous anomalies may promote the growth of brainstem CMs and drain the vein surrounding the lesions, but the role of the venous environment in the pathogenetic mechanism of brainstem CMs remains uncertain. 4,55,71 Preservation of the associated DVA was a primary goal in most studies, [2][3][4][5]19,25,28,32,36,37,46,57,64,69,71 but some studies challenged this prevalent thinking. 71,72 Yamada et al 72 suggested that a venous malformation could safely be removed as a "pericapillary arteriovenous malformation."…”

Cerebral Cavernoamas : Radiological Prevalence and Clinical Features in a 10 Year Retrospective Study in a Teaching Hospital = الأورام الوعائية الكهفية الدماغية : دراسة انتشار شعاعية مع المظاهر السريرية : دراسة استعادية لفترة عشر سنوات في مستشفى تعليمي

“…No correlation was found between size of cavernous angioma and initial presentation [4] .Risk factors for aggressive clinical behavior of cavernous angioma include familial or multiple forms, previous brain radiotherapy, incomplete removal, associated venous malformation and previous hemorrhage. Cavernous angioma radiological appearances is regarded as pathognomenic but some pathologies can mimic cavernous angioma, most common are hemorrhagic neoplasm especially metastatic cancer while others include meningioma, gliomas, other vascular malformation and cysticercosis [7] . Cavernous angioma are most commonly found in supratentorial region (80%) and are preferentially located cortically at subcortical white matter, a deep location in basal ganglia, hypothalamus or ventricular system is infrequent [4] .…”

Petrosal approaches to brainstem cavernous malformations

“…3,11,17 Results Incorporating our own results (with 2 cases not published in the literature), we found 65 cases of brainstem CMs resected via a petrosal approach in 20 reports. 1,5,7,12,13,21,25,27,30,32,36,39,40,42,44,46,48,50,51,53 The specific approaches were posterior petrosal in 37 cases (57%), anterior petrosal in 17 (26%), extended posterior petrosal in 10 (15%), and a combined petrosal approach in 1 (2%) ( Table 1). Extended posterior petrosal approaches included the transcrusal approach (partial labyrinthectomy) in 5 cases (8%), petrosal translabyrinthine approach in 4 (6%), and the petrosal transcochlear approach in 1 case (2%).…”