Surgical removal of pontomesencephalic cavernous hemangiomas

R. Fahlbusch, C. Strauss, W. Huk, G. Rockelein, D. Kompf, K. W. Ruprecht, B. M. Stein, R. E. Wharen

Research output: Contribution to journalArticlepeer-review

105 Scopus citations

Abstract

Cavernous hemangiomas of the brain stem are usually discovered accidentally during evacuation of a hematoma, and successful surgical treatment of these lesions is seldom achieved. With the increasing use of magnetic resonance imaging, the presence of a cavernous hemangioma can be detected before surgery, allowing an elective surgical approach. We successfully removed pontomesencephalic cavernous hemangiomas from 2 patients and pontomedullary hemangiomas from 2 others. Elective surgery was performed with perioperative bimodal monitoring of somatosensory and auditory evoked potentials. Performing surgery soon after the hemorrhage minimizes the risk of additional postoperative neurological deficit, since surgical excision is facilitated when the hematoma is not completely organized. Pontine hemangiomas are approached via the 4th ventricle. Mesencephalic hemangiomas are removed by a midline supracerebellar approach when they are lateralized by using a subtemporal approach. The lesion can be removed through a small incision in the brain stem at the site of the lesion. The favorable results, which include marked improvement of preoperative neurological deficits and documentation of complete removal of the lesion by magnetic resonance imaging, support a more aggressive approach to the treatment of symptomatic cavernous hemangiomas of the brain stem. Further investigation of the natural history of these lesions is mandatory.

Original languageEnglish (US)
Pages (from-to)449-457
Number of pages9
JournalNeurosurgery
Volume26
Issue number3
DOIs
StatePublished - 1990

Keywords

  • Brain stem hemorrhage
  • Brain stem surgery
  • Cavernous hemangiomas

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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