gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Cavernous malformations of the brainstem – Long-term outcome after microsurgical resection

Meeting Abstract

  • C. Schwartz - Neurochirurgische Klinik, Ludwig-Maximilians-Universität, München
  • A. Grillhösl - Abteilung für Neuroradiologie, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • J.C. Tonn - Neurochirurgische Klinik, Ludwig-Maximilians-Universität, München
  • S. Zausinger - Neurochirurgische Klinik, Ludwig-Maximilians-Universität, München

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.09.01

DOI: 10.3205/11dgnc058, URN: urn:nbn:de:0183-11dgnc0589

Published: April 28, 2011

© 2011 Schwartz et al.
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Outline

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Objective: To retrospectively examine clinical and radiological long-term outcome of patients with a history of resection of a brainstem cavernous malformation (BSCM).

Methods: We identified 27 patients who underwent microsurgical resection of a BSCM between 2001 and 2008; 5/27 pts were not eligible due to the lack of current contact data. All 22 patients (male:female 1:1.75, mean age at operation: 41.2 ± 14.3 y) had experienced symptomatic hemorrhages with neurological deterioration. Preoperatively, all patients received a 3D-CISS MRI to identify the lesion and its spatial correlation to adjacent cranial nerves with the aim to determine safe entry zones. All patients were evaluated clinically and radiologically 3-6 months postoperatively, 16 underwent an additional follow-up examination in 2009/2010 (mean follow-up 55.2 ± 23.0 months). All patients completed Barthel-ADL index questionnaires and telephone interviews.

Results: Postoperative. MRI studies revealed complete resection of BSCMs in all patients. Post-hemorrhagically 13/22 suffered from single/multiple cranial nerve deficits and 14/22 from unilateral hemispheric symptoms. 1/13 patients with post-hemorrhagic CN deficits, 3/8 patients with unilateral motor and 3/10 patients with unilateral sensory deficits showed complete resolution of symptoms before surgery. Of 12 patients with preoperative 21 CN deficits, an aggravation of deficits was never recorded, 8 and 13 CN deficits, respectively, remained unchanged or improved, while 6/21 CN deficits completely resolved after surgery until the end of follow-up. Concerning CN deficits, 4/22 patients suffered from a new and permanent cranial nerve deficit (mostly VII-palsy) after surgery. Of 5 patients with preoperative motor symptoms, one patient showed a worsening of symptoms, one remained unchanged, and 3/5 showed an improvement with one case displaying complete resolution of symptoms. 1/22 cases suffered from a new postoperative permanent motor deficit. Among 7/22 patients with preoperative permanent sensory deficits, postoperative aggravation of symptoms was recorded in one patient, 3/7 showed an unchanged status and 3/7 had an improved status. Complete resolution was recorded in 2/7 cases. Mean pre- and postoperative Barthel-Index scores were found to be 90.5 ± 17.0 and 94.6 ± 12.4 (p = 0.4).

Conclusions: Complete resection of BSCM can be achieved with moderate risk and low long-term morbidity. Surgical treatment of BSCMs is recommended in symptomatic patients, in whom the lesion is accessible for surgery.