5th Annual Meeting of Serbian Neurosurgical Society, Zaječarski, Serbia, 24 - 27 October 2019
Our approach and experience with adult brainstem cavernous malformations.
Usseli Mİ, Güdük M, Ekşi MŞ, Güngör A, Pamir MN.
Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, İstanbul, Turkey.
Background: Cavernous malformations (CMs) are vascular malformations with an incidence of 0,5% in general population, comprimising 5-10% of all intracranial vascular malformations. Brainstem cavernomas (BSCs) have a prevelance of 4-35% among all other intracranial CMs. BSCs have distinct place among other intracranial CMs due to peculiar location and potential devastating events. Treatment approaches could not have been standardized due to these unrelenting situations. Our aim was to analyze our surgical series operated by the same senior surgeon (MNP) with a full-filled experince of microsurgical techniques at this eloquent region of the brain.
Methods: This is a retrospective review of prospectively collected database. Patient charts, cranial MRIs, pathology reports, and outpatient notes were collected.
Results: There were 45 patients with BSCs. Of 45 patients, 20 (45%) were women and 25 (55%) were men. Mean age was 30,8 years (range: 18-67 years). Specfic tumor locations were pineal region (4,5%), thalamus (13,5%), mesencephalon (7%), pons (64%), and medulla oblongata (11%). Mortality rate was 0%. There were cranial nerve deficit in 24%, motor deficit in 18%, sensorial deficit in 9% and ataxia/other cerebellar signs in 13% of the patients in the early postoperative period. Better or the same clinical/neurological status could be achieved in 82% of the patients. Literature review denoted a 75-100% total resection rate, 0-69% immediate post-op neurological deficit, 0-4% mortality rate and 44-100% same or better outcome.
Conclusion: Despite demanding surgical skills for surgical approch to BSCs, surgery could be accomplished safely and effectively in selected cases with appropriate indications.