Brainstem cavernous malformations

Bradley A. Gross, H. Hunt Batjer, Issam A. Awad, Bernard R. Bendok

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

BRAINSTEM CAVERNOUS MALFORMATIONS (CMs) continue to present a considerable source of controversy in the neurosurgical community, with an accumulating volume of literature detailing their natural history and their surgical and radiosurgical management. As part of a systematic review of the literature, 12 natural history studies, 52 surgical series, and 14 radiosurgical series were tabulated. Annual bleeding rates for brainstem CMs ranged from 2.3% to 4.1% in natural history studies and from 2.68% to 6.8% in surgical series before intervention. Rebleed rates as high as 21.5% in natural history studies and greater than once per year in surgical series were reported. A total of 684 of 745 CMs (92%) were documented as completely resected in 46 series that provided specific information on resection rates. Early postoperative morbidity ranged from 29% to 67% in larger surgical series, although it was often transient. Thirty of 61 partially resected lesions rebled; 4 of these rebleeds were fatal. Twelve additional patients died from surgically related causes for a combined postoperative rebleeding and surgically related mortality rate of 1.9%. Across 45 series (683 patients), 85% of patients were reported as the same or improved, 14% were worse, and 1.9% died from surgically related causes at long-term follow-up. Patients with anterolateral pontine lesions generally appeared to have a better functional recovery, whereas those requiring excision via the floor of the fourth ventricle had relatively worse long-term outcomes. Radiosurgical series demonstrated conflicting data; some reported a statistically significant decrease in CM rebleeding rates after 2 years, whereas others did not, partially related to dosimetry. Postradiosurgical morbidity was nonetheless significantly greater for CMs than for arteriovenous malformations.

Original languageEnglish (US)
Pages (from-to)E805-E818
JournalNeurosurgery
Volume64
Issue number5
DOIs
StatePublished - May 1 2009

Keywords

  • Angioma
  • Brainstem
  • Cavernous malformation
  • Cranial base approach
  • Natural history
  • Radiosurgery
  • Skull base approach
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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