Peer-Review ReportBrainstem Cavernous Malformations: 1390 Surgical Cases from the Literature
Introduction
Among the variety of lesions faced by vascular neurosurgeons, brainstem cavernous malformations (CMs) present a considerable microsurgical challenge and were once the subject of rare case reports (13, 45, 51). After large series were reported by the Barrow Neurological Institute in 1999 (40) and the Beijing Neurosurgical Institute in 2003 (53), an explosion of studies surfaced in the literature detailing the results of surgical resection (9, 16, 18, 50). Amidst this, we previously amassed results from 52 surgical series with 821 patients and found a 92% complete excision rate with 85% of patients being improved or the same at long-term follow-up (18). Impressively, since this initial report, a litany of series with nearly as many patients have been reported (1, 2, 6, 10, 11, 12, 15, 17, 20, 22, 23, 30, 32, 36, 42, 44, 49, 50), prompting us to amass their results, compare them, and combine them with those of our previous report.
Section snippets
Methods
The PubMed database was queried with the search terms “cavernoma,” “cavernous malformation,” “cavernous angioma,” “brainstem,” and “surgery” from May 2008 to January 2012. As per our previous selection criteria, any series containing at least three patients with brainstem CMs undergoing surgery was included. This resulted in 18 reports (1, 2, 6, 10, 11, 12, 15, 17, 20, 22, 23, 30, 32, 36, 42, 44, 49, 50), two of which were inclusive, larger updates of previous series in the literature (2, 5, 15
Results
During the last 3.5 years, 18 surgical series containing at least three patients with brainstem CMs were reported, including the largest study of 260 patients reported by Abla et al. (2). These 18 series included a total of 710 patients (median: 26.5 patients), a similar total to the 821 patients presented across 52 surgical series over the prior 21 years. Results are summarized in Table 1.
Comparing these new series to those amassed in our previous report (Table 2), we found the same 92%
Discussion
Previously confused with demyelinating disease (3, 7, 52), brainstem gliomas (47, 55), and even strokes (25, 27), brainstem CMs are now recognized as a curable cause of morbid brainstem injury. Concomitant with advances in magnetic resonance imaging techniques, small surgical series detailing the resection of brainstem CMs began to surface in the late 1980s (29, 55) with a subsequent explosion of studies undertaken during the past decade (2, 9, 15, 16, 18, 50, 53). Although the results provided
Conclusion
Brainstem CMs continue to present a considerable microsurgical challenge, with high early postoperative morbidity rates (45%) and long-term worsening in approximately 15% of patients after surgery. Complete excision, achieved in 91% of cases overall, should be the goal, as 62% of partially resected CMs rebled postoperatively. Even as an alternative only to observation, CM SRS is still reviewed with skepticism.
References (55)
- et al.
Brainstem cavernous malformations
J Clin Neurosci
(2010) - et al.
Microroll retractor for surgical resection of brainstem cavernomas
World Neurosurg
(2010) - et al.
A single institution series of cavernomas of the brainstem
J Clin Neurosci
(2011) - et al.
Surgical management of brain-stem cavernous malformations: report of 137 cases
Surg Neurol
(2003) - et al.
Radical surgery on cavernous angioma of the brainstem
Surg Neurol
(1986) - et al.
Cavernous malformations of the brainstem presenting in childhood: surgical experience in 40 patients
Neurosurgery
(2010) - et al.
Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients
Neurosurgery
(2011) - et al.
Spontaneous intracerebral hemorrhage in patients suspected of multiple sclerosis
J Neurol Neurosurg Psych
(1971) - et al.
Temporal clustering of hemorrhages from untreated cavernous malformations of the central nervous system
Neurosurgery
(2001) - et al.
Cerebral cavernous malformations in the adultReview of the literature and analysis of 72 surgically treated patients
Neurosurg Rev
(2002)
Management of pediatric brainstem cavernous malformations: experience over 20 years at the Hospital for Sick Children
J Neurosurg Pediatr
Occult arteriovenous malformation of the brainstem simulating multiple sclerosis
Neurology
The two-point method: evaluating brainstem lesions
BNI Q
Early surgery for brainstem cavernomas
Acta Neurochir (Wien)
Post-operative remnants of brainstem cavernomas: incidence, risk factors and management
Acta Neurochir (Wien)
Surgical strategies in treating brainstem cavernous malformations
Neurosurgery
Treatment and outcome of children with cerebral cavernomas: a survey on 32 patients
Neurol Sci
Venous abnormalities and angiomas of the brain
Arch Surg
Supracerebellar infratentorial approach to cavernous malformations of the brainstem: surgical variants and clinical experience with 45 patients
Neurosurgery
Quality of life after brainstem cavernoma surgery in 71 patients
Neurosurgery
Brainstem cavernomas: Long-term results of microsurgical resection in 52 patients
Neurosurgery
Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas
Acta Neurochir (Wien)
Brainstem cavernous malformations
Neurosurgery
The natural history of intracranial cavernous malformations
Neurosurg Focus
Symptomatic brainstem cavernomas
Neurosurgery
The presigmoid approach to anterolateral pontine cavernomas
J Neurosurg
Transpetrosal approach for aneurysms of the lower basilar artery
J Neurosurg
Cited by (126)
3-Dimensional Exoscope for Far Lateral Approach to Pontomedullary Cavernous Malformation
2022, World NeurosurgeryCavernous malformations
2022, Progress in Brain ResearchPredictive Value of Intraoperative Neuromonitoring in Brainstem Cavernous Malformation Surgery
2021, World Neurosurgery
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.