gms | German Medical Science

Objective: When treating cerebral cavernous malformation surgically, maximum safe resection is the desired goal. Factors like complex shape, multiple lesions or location can make this goal harder to achieve. The resection of hemosiderin might play a separate and important role when aiming for seizure reduction.

With all that in mind, we examined the effect of intraoperative magnetic resonance imaging (ioMRI) on the operative result of cavernoma patients.

Methods: For this study we retrospectively analyzed all consecutive cases of cavernous malformation resection operated in our department since 2009. Multiple parameters such as age, cavernoma volume, hemosiderin ring size, eloquence, location, outcome and additional resection after ioMRI were examined. Cavernoma volumetric analysis was performed using Brainlab Elements Software. Statistical analysis was performed by SPSS, significant level was set for p<0.05.

Results: Out of 37 patients total, 31 (83.8%) underwent iMRI assisted cavernoma resection. Mean age was 39 years (range 7-69 years), 51.6% (N=16) were male. Most common cavernoma location was frontal lobe (N=12, 38.7%). The Brainstem was affected in 3 patients (9.7%). In 9 patients (29.0%) had deep seated lesions. Irregular shaped lesions were found in 21 cases (67.7%). Familiar history of cavernoma was noted in 8 patients (25.8%). Mean tumor volume was 4.2 cm³ (SE 0.91). Mean ring diameter was 3.08 mm (SE 0.40). Excellent outcome was achieved in 27 patients (87.1%). Only 1 patient had a bad outcome due to a surgery related complication. Engel I grade was achieved in 28 patients (90.3%). After ioMRI, additional tumor resection was performed in 15 cases (48.4%). The most common reasons were infratentorial location (40%, N=6/15), cavernomatosis (40%, N=6/15) and macrobleeding (20%, N=3).

Conclusion: ioMRI might be a useful tool for cavernoma resection especially in complex deap seated infratentorial lesions or in the case of cerebral cavernomatosis. Furthermore, ioMRI might offer special value in achieving gross total resection including hemosiderin ring which could be a potential epileptogenic focus.