gms | German Medical Science

Objective: Brainstem cavernomas are benign vascular malformations; however, they can cause severe neurological deficits when haemorrhaging. Removal of these lesions has been related with a high surgical morbidity, and there is no general consent on the surgical management of these lesions. It was the goal of this study to review the surgical results of a recent series of brainstem cavernomas. Intraoperative navigation made use of MR based brainstem tractography, whereas intraoperative electrophysiological mapping of the brainstem was done to optimize resection.

Methods: A total of 20 consecutive patients with cavernomas in the brainstem were included in this study. All treated patients suffered at least one haemorrhage before they underwent surgical treatment. Presenting symptoms included facial palsy, diplopia, dizziness, headaches, and gait disturbance. Pre-operative neuroradiological examinations included MRI with diffusion tensor imaging (DTI) to visualize brainstem tracts.

Results: Minimally invasive approaches including the pterional, medial and lateral supracerebellar, retrosigmoid and the medial suboccipital approach were used. Brainstem mapping was used to determine a safe point of entry. Microsurgical resection of the cavernomas was performed under continuous intra-operative monitoring. A total tumor removal was achieved in 19 cases and new cranial nerve deficits were observed in only two patients after surgery.

Conclusions: Our results show that by using a refined microsurgical technique combined with minimally invasive approaches, neurophysiological monitoring and brainstem mapping, a total resection of brainstem cavernomas can be achieved with a very low surgical morbidity.