Microsurgical Removal of Brainstem Cavernous Malformations

Objective: To summarize the clinical features of brainstem cavernous malformations (BSCM) and to evaluate the efficacy of the surgical treatment of BSCM. Methods: The clinical data of 41 patients with BSCM who were treated by microsurgical resection during the period of January, 2003 to April, 2011 were analyzed retrospectively. Results: The 41 patients of ages 8 to 62 years included 23 males and 18 females. Surgical approaches were selected according to the sites of the lesions, following the principle of “the shortest distance from the incision to the lesion.” Intraoperative, short-latency, somatosensory evoked potential, and auditory evoked potential monitoring were used. Total resection was achieved in 35 cases. Six patients with giant lesions had residues. No deaths occurred. Overall 27 patients received an improvement of nerve function. An aggravation of preexisting neurological disorders or an appearance of new neurological disorders was found in 14 patients, including 2 patients who had a respiratory dysfunction, but regained spontaneous breathing after 1 week of assisted respiration. The follow-up was performed at 38 months on average. Neurological deficits have been restored in most patients and no recurrence has been found except for one case of rebleeding with a residual tumor. Conclusions: An individualized surgical approach is necessary in the resection of BSCM. The application of intraoperative navigation and electrophysiological monitoring is helpful.