Treatment of Brainstem Cavernomas

Lee, Sang Bok; Lee, Jung Il; Kim, Jong Soo; Hong, Seung Chyul; Park, Kwan

Abstract

OBJECTIVE
The goal of this study is to evaluate the clinical outcome of the patients with brainstem cavernous angiomas after treatment with microsurgery or radiosurgery.
METHODS
Fifteen patients with brainstem cavernous angiomas were treated at the authors' institution between 1995 and 2003. Clinical record and neuroimaging examinations were retrospectively reviewed.
RESULTS
Ten patients underwent microsurgical resection. Radical excision was achieved in all of them. In 6 patients (60%), transitory neurological deterioration or new neurological deficit after immediate postoperative period. The final outcomes at 6-70 months after surgery were improved in 8 patients (80%) and unchanged in 2 (20%) compared with preoperative state. Radiosurgery was performed as an initial treatment in 6 patients. During the follow up period from 5 to 60 months there was neurological improvement in 3 patients and no significant change in 2. One patient developed rebleeding at 60 months after radiosurgery and underwent microsurgical resection.
CONCLUSION
Symptomatic cavernous angioma of brainstem can be treated with microsurgical resection with acceptable morbidity. Radiosurgery is an effective alternative for the lesion which is not accessible by surgical approach, however, still there is possibility of rebleeding over long period after radiosurgical treatment. Fatal complication is rare with appropriate surgical approach in well selected patient. Microsurgery should be considered as a treatment with priority for the majority of cases.