Early surgery for brainstem cavernomas

• Published in: Acta neurochirurgica Vol. 148; no. 4; pp. 405 - 414
• Main Authors: Bruneau, M, Bijlenga, P, Reverdin, A, Rilliet, B, Regli, L, Villemure, J-G, Porchet, F, de Tribolet, N
• Format: Journal Article
• Language: English
• Published: Austria Springer Nature B.V 01.04.2006
• Subjects: Adolescent; Adult; Aged; Bleeding; Blood Vessels - pathology; Blood Vessels - physiopathology; Brain stem; Brain Stem - blood supply; Brain Stem - pathology; Brain Stem - surgery; Cerebellum; Child; Consciousness Disorders - etiology; Consciousness Disorders - physiopathology; Consciousness Disorders - surgery; Cranial Nerve Diseases - etiology; Cranial Nerve Diseases - physiopathology; Cranial Nerve Diseases - surgery; Cranial nerves; Disease Progression; Female; Hemangioma, Cavernous, Central Nervous System - diagnosis; Hemangioma, Cavernous, Central Nervous System - physiopathology; Hemangioma, Cavernous, Central Nervous System - surgery; Hemorrhage; Humans; Male; Middle Aged; Morbidity; Neurological diseases; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Neurosurgical Procedures - statistics & numerical data; Patients; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Postoperative Hemorrhage - prevention & control; Recovery of Function - physiology; Recurrence; Reoperation - statistics & numerical data; Retrospective Studies; Risk Assessment; Statistical analysis; Surgery; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Vascular Surgical Procedures - statistics & numerical data
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-005-0671-7

The purpose was to review our experience with the surgical management of brainstem cavernomas (BSCs) and especially the impact of the surgical timing on the clinical outcome. We retrospectively reviewed 22 patients harboring a BSC, who underwent 23 procedures. Surgery was carried out during the early stage after the last haemorrhage, with a mean delay of 21.6 days (range 4-90 days). Sixteen procedures were performed after a first bleeding event while seven after multiple bleedings. Complete resection was achieved in 19 patients (86.4%). Early after surgery, 12 patients (52.2%) improved neurologically, 5 (21.7%) were stable and 6 (26.1%) worsened. New postoperative deficits were noted after 9 procedures (39.1%). Statistically significant factors for postoperative aggravation were: late surgery (P = 0.046) and multiple bleedings (P = 0.043). No patient operated on within the first 19 days after bleeding did worsen (n = 11), as opposed to 6 out of 12 who did when operated on later. After a mean follow-up of 44.9 months, 20 patients (90.9%) were improved, 1 patient (4.6%) was worse and 1 patient was lost to follow-up (4.6%), after reoperation for rebleeding of a previously completely resected cavernoma. Late morbidity was reduced to 8.6%. The mean Glasgow Outcome Scale (GOS) at the end of the follow-up period was 4.24, compared to a mean preoperative GOS of 3.22 (P<0.001). Complete neurological recovery of motor deficits, sensory disturbances, cranial nerves (CNs), internuclear ophtalmoplegia and cerebellar dysfunction were respectively 41.7%, 38.5%, 52.6%, 60.0% and 58.3%. Among the most affected CNs: CN 3, CN 5 and CN 7 were more prone to completely recover, respectively in 60.0%, 70.0% and 69.2%. Surgical removal of BSCs is feasible in experienced hands with acceptable morbidity and good outcome. Early surgery and single bleeding were associated with better surgical results.