The indications for treatment of cavernous malformations of the brain stem have evolved greatly in the past decade. As more experience has been gained with these lesions, it has become evident that surgical excision is possible with acceptable rates of surgical morbidity and mortality. Criteria for surgical indications include a symptomatic lesion that reaches a pial or ependymal surface and that can be reached without the need to traverse eloquent brain stem parenchyma. Advances in frameless stereotactic systems have improved localization and made resection safer, even for "intrinsic" symptomatic lesions that are reached through a small incision in "safe entry-zones" on the surface of the brain stem. Although with caution, surgical excision should also be considered for selected young asymptomatic patients with relatively large lesions that reach a pial or ependymal surface. This article summarizes the clinical characteristics, indications for surgery, technical surgical pitfalls, and outcomes of surgical resection of brain stem cavernous malformations. 2002, Elsevier Science (USA). All rights reserved.
ASJC Scopus subject areas
- Clinical Neurology