Abstract
Abstract
Background
The purpose of this study was to clarify whether the intrinsic depth of midbrain cavernous malformations (MCMs) influenced the surgical outcome.
Methods
The authors conducted a retrospective study of 76 consecutive patients who underwent microsurgical resection of a MCM. The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery.
Results
Twenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group nl). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group yw). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group bg). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group ex). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up.
Conclusion
This study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.
Funder
INI – International Neuroscience Institute Hannover GmbH
Publisher
Springer Science and Business Media LLC
Subject
Clinical Neurology,Surgery
Reference32 articles.
1. Abla AA, Lekovic GP, Turner JD, de Oliveira JG, Porter R, Spetzler RF (2011) Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. Neurosurgery 68:403–414
2. Bertalanffy H (2016) Avoidance of postoperative acute cerebellar swelling after pineal tumor surgery. Acta Neurochir 158:59–62
3. Bertalanffy H, Benes L, Miyazawa T, Alberti O, Siegel AM, Sure U (2002) Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients. Neurosurg Rev 25:1–53
4. Bertalanffy H, Florian IA, Timiș TL (2020) Cavernous malformations of the pineal region: overview, management, and controversies. S.I. Florian (editor) Pineal region lesions: management strategies and controversial issues. Springer Nature Switzerland AG, pp 197–212. https://doi.org/10.1007/978-3-030-50913-2_22
5. Bertalanffy H, Tissira N, Krayenbuhl N, Bozinov O, Sarnthein J (2011) Inter- and intrapatient variability of facial nerve response areas in the floor of the fourth ventricle. Neurosurgery 68:23–31
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