Surgical management of pediatric brainstem cavernous malformations

Li, Da; Hao, Shuyu; Tang, Jie; Xiao, Xinru; Jia, Guijun; Wu, Zhen; Zhang, Liwei; Zhang, Junting

doi:10.3171/2014.2.peds13536

Cited by 47 publications

(33 citation statements)

References 48 publications

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“…[497][498][499] Brainstem CMs are far more challenging; surgical resection generally carries greater risks than observation (resection has been associated with 6% mortality, 33% perioperative morbidity, and 21% persistent iatrogenic deficits). 500,501 There has been debate about the utility of extirpation of asymptomatic lesions. For patients with multiple CMs, resection should be limited to symptomatic lesions or lesions with documented expansion over time.…”

Section: Cavernous Malformationsmentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

530

515

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Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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Section: Cavernous Malformationsmentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

530

515

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“…Intradural extramedullary cavernous malformations present with SAH in about one third of the cases 3,9 . Treatment of cavernous malformation in general remains controversial. Size, location, presence of hemorrhage, history of seizure and age are some factors considered for surgical decision 5,7 . Intradural extramedullary cavernous malformations seems to have a different natural history that their intraparenchimal counterpart with a major tendency to bleed.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid Hemorrhage Caused by an Extramedullary Intradural Foramen Magnum Cavernous Malformation

Neto¹,

Paz²,

Stávale³

et al. 2018

jbnc

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Objective: Pure subarachnoid hemorrhage (SAH) secondary to spine cavernous malformation is rare. Method: Female, 41 year old, with a massive intraventricular and SAH secondary to a extramedullary intradural foramen magnum cavernous malformation. The patient developed a sudden headache and drowsiness without neurological deficits. A CT scan revealed a massive SAH without intraparenchymal blood. Angiogram was negative for aneurysm or vascular malformation. A MRI showed an extramedullary intradural mass in the foramen magnum. She underwent a neurosurgical resection of the mass. Results: No complications due to resection and the pathological test revealed a cavernous malformation. Conclusion: This is the second case of foramen magnum cavernous malformation reported in literature. It should be considered a differential diagnosis of SAH with negative angiogram and surgical treatment usually provides good outcomes. Objetivo: Hemorragia subaracnoide (HSA) secundária a cavernoma medular é um evento raro. Método: Relatamos caso de paciente do sexo feminino, negra, 41 anos, que apresentou HSA causada por cavernoma com localização intradural extramedular na região do forame magno. A paciente apresentou quadro de HSA confirmado por TC de crânio e RM de crânio demonstrou presença de lesão extramedular ao nível do forame magno. A paciente foi submetida a tratamento cirúrgico da lesão. Resultados: Boa evolução pós-operatória e confirmação patológica de diagnóstico de cavernoma. Conclusão: Este é o segundo caso de cavernoma intradural extramedular da região do forame magno descrito na literatura. Esta patologia deve ser considerada no diagnóstico diferencial de HSA com angiografia negativa. Palavras-chave:Cavernoma, Forame Magno, HSA Extramedular Caused by an Extramedullary Intradural Foramen Magnum cavernous malformation J Bras Neurocirurg 25 (2): 136 -

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“…In the pediatric population, the indication includes multiple hemorrhages, lesions equal or bigger than 2cm, severe or progressive deficits, exophytic lesions, and mass effect on the brainstem. 9 The treatment of choice is surgery, 4-6 weeks after bleeding, although the time is still controversial because the approach is easier in the period that the hematoma is not yet organized; in this case, the goal is the complete removal, preventing recurrence of bleeding and functional worsening. 1,14,15 However, before indicating the surgical procedure, the main differential diagnosis (pontine glioma and multiple sclerosis) must be excluded.…”

Section: 410-13mentioning

confidence: 99%

“…1,[5][6][7][8] In the pediatric population, the lesion is found in the pons (rate of 73%), and it presents a 12.3% rate of bleeding per year and a 32.5% rate of rebleeding per year. 9 There is a genetic inheritance relationship, autosomal dominant, associated to the CCM1 gene (cerebral cavernous malformation 1), CCM2, and CCM3.…”

Section: Introductionmentioning

confidence: 99%

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Anterior pontine cavernoma: what should be done?

Neves¹,

Aguiar²,

Belsuzarri³

et al. 2017

ATROA

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Introduction: Anterior pontine cavernomais a rare pathology with difficult access; it predominantly occurs in middle-aged patients with a high risk of bleeding and rebleeding. There is a direct association with genetic inheritance due to the CCM1, CCM2 and CCM3 genes, and if it is associated, there is a higher risk of severity. Materials and methods:Analysis of PUBMED publications about ventral pontine cavernomas, anterolateral pontine cavernomas, and main surgical approaches.Results and discussion: Pontine cavernomas have a bleeding risk of 5% per year and rebleeding of 30% per year; therefore, it is a surgical pathology in which most authors approach from four to six weeks after bleeding for total resection and curative purposes. There are different approaches and they depend on the topography of the lesion and the surgeon`s ability; technologies such as monitoring, neuronavigation, and tractography must be used to reduce the risk of lesions. The most used approaches are retrosigmoid, presigmoid, and anterior transpetrosal; the use of endoscopic approaches has been increasing recently. Conclusion:Anterior pontine cavernoma is a severe pathology that must be surgically treated to decrease the risk of bleeding and rebleeding.

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Surgical management of pediatric brainstem cavernous malformations

Cited by 47 publications

References 48 publications

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Subarachnoid Hemorrhage Caused by an Extramedullary Intradural Foramen Magnum Cavernous Malformation

Anterior pontine cavernoma: what should be done?

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