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Surgical management of brain-stem cavernomas

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Abstract

We present a series of seven patients who were operated on for symptomatic brain-stem cavernomas. The following approaches were used: medial suboccipital (N = 4), lateral suboccipital (N = 1), subtemporal-transtentorial (N = 1), and frontal transcortical-transventricular-subchorioidaltrans velum interpositum (N = 1). Intraoperative motor (N = 4) and somatosensory (N = 1) evoked potential monitoring revealed temporary changes in 3 patients. Immediately postoperatively, the following additional deficits were observed in 6 patients: oculomotor nerve paresis (N = 2), abducens nerve paresis (N = 3), facial nerve paresis (N = 2), deafness (N = 1), and increased ataxia (N = 3). One patient died due to septic complications not related to surgery. After a mean observation time of 2 years, 2 patients had improved, 3 were unchanged, and 1 patient deteriorated as compared to his preoperative status. In conclusion, surgical treatment of brain-stem cavernomas, although carrying a significant risk of temporary neurological deterioration is recommended in symptomatic patients in whom the cavernoma seems to reach the surface of the brain-stem. Intraoperative functional topographic mapping and monitoring have proven useful tools lowering the surgical risks in these patients.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Bonn, Sigmund-Freud-Str.25, D-53105, Bonn, Fed. Rep. of Germany

    Ulrich Pechstein M.D., Josef Zentner, Dirk Van Roost & Johannes Schramm

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  1. Ulrich Pechstein M.D.
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  2. Josef Zentner
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  3. Dirk Van Roost
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  4. Johannes Schramm
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Pechstein, U., Zentner, J., Van Roost, D. et al. Surgical management of brain-stem cavernomas. Neurosurg. Rev. 20, 87–93 (1997). https://doi.org/10.1007/BF01138189

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  • DOI: https://doi.org/10.1007/BF01138189

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