gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

A comparison between superficial and deep-seated cavernous malformations of the brainstem: Surgical technique and results

Meeting Abstract

  • Marcos Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Guilherme Lepski - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Kristofer Ramina - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Marina Liebsch - Klinik für Neurochirurgie, Universitätsklinikum Tübingen
  • Günther Feigl - Klinik für Neurochirurgie, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.19.02

doi: 10.3205/13dgnc163, urn:nbn:de:0183-13dgnc1630

Published: May 21, 2013

© 2013 Tatagiba et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Cavernous malformations (CM) are low-flow vascular malformations. However, these lesions can cause severe neurological symptoms and deficits when hemorrhaging within the brainstem (BS). Removal of BS CMs has been associated with a high surgical morbidity, and there is no general consent especially on when to treat deep-seated BS CMs. This study aims to compare the surgical results of a series of deep-seated BS CMs with the surgical results of a series of superficially located BS CMs, operated in one single Institution. The authors explain the rational of decision making for surgical treatment, and describe their refined operative technique for the removal of deep-seated BS CMs.

Method: A retrospective evaluation was performed. Pre-operative radiological examinations included MRI with Gadolinium contrast enhanced T1 and T2 sequences as well as diffusion tensor imaging (DTI) to visualize brainstem fiber tracts. In deep-seated BS CMs a 3D voxelbased neuronavigation system and electrophysiological mapping of the brainstem surface were used to custom tailor the surgical approach and determine the shortest distance to the lesion and a safe point of entry. All operated patients had suffered at least one acute or previous episode of hemorrhaging before surgical treatment was recommended.

Results: A total of 34 consecutive patients with primary superficial (n=20 / 58.8%) and deep-seated (n=14 / 41.2%) brainstem cavernomas (BS CM) were included in this comparative study. A total removal was achieved in 31 patients (91.2%). Deep seated BS CMs: The mean diameter was 14.7 mm (range 8.3–27.7 mm). All but one of these lesions could be removed completely. The median follow-up time was 5.8 years. Two patients (5.9%) suffered from new neurological deficits after surgery. Superficial BS CMs: The mean diameter was 14.9 mm (range 7.2–27.3 mm). All but two of the superficial BS CMs could be removed completely. New permanent neurological deficits after surgery were observed in two patients (5.9%). The median follow-up time in this group was 3.6 years.

Conclusions: Treatment of BS CMs remains very complex. Results of this study show that with adequate approaches, brainstem mapping and the use of the “spinal cord dissection technique” deep-seated BS CMs can be removed completely in selected cases with a good functional outcome, comparable with superficial BS CMs.