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Symptomatic cavernous malformations of the brainstem: functional outcome after microsurgical resection

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Abstract

Brainstem cavernous malformations are associated with a considerable risk of hemorrhage and subsequent morbidity. This study provides a detailed work-up of clinical and radiological outcome as well as identification of prognostic factors in patients who had suffered from symptomatic hemorrhages. Patients who had undergone surgery of symptomatic BSCMs were evaluated pre- and postoperatively both neurologically and neuroradiologically supplemented by telephone interviews. Additionally, patients were scored according to the Scandinavian Stroke Scale. Multiple uni- and multivariate analyses of possible clinical and radiological prognostic factors were conducted. The study population comprised 35 patients. Mean age at operation was 39.3 ± 13.0 years with microsurgical resection of a total of 37 different BSCMs between 2002 and 2011. Median clinical follow-up was 44.0 months (range 8–116 months). Postoperative MRI showed eventually complete resection of all BSCMs. Postoperative overall outcome revealed complete resolution of neurological symptoms for 5/35 patients, 14/35 improved and 9/35 remained unchanged. 7/35 suffered from a postoperative new and permanent neurological deficit, mostly affecting the facial nerve or hemipareses with mild impairment. Pre- and postoperative Scandinavian Stroke Scale scores were 11.0 ± 2.4 and 11.4 ± 2.2 (p = 0.55). None of the analyzed factors were found to significantly correlate with patients’ clinical outcome. Complete resection of brainstem cavernous malformations can be achieved with an acceptable risk for long-term morbidity and surgery-related new deficits (~20 %). Neurological outcome is mainly determined within the first 6 months after surgery. Surgical treatment of brainstem cavernous malformations is recommended in symptomatic patients, in whom the lesion is accessible for surgery.

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Conflicts of interest

No conflicts of interest have arisen throughout conduction of the study.

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Authors and Affiliations

  1. Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Christoph Schwartz, Christian Schichor, Bogdana Suchorska, Alexander Romagna, Jörg-Christian Tonn & Stefan Zausinger

  2. Department of Neuroradiology, Ludwig-Maximilians-University Munich, Munich, Germany

    Andreas Grillhösl

  3. Berufsgenossenschaftliche Unfallklinik Murnau, Institute of Radiology, Murnau, Germany

    Andreas Grillhösl

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  1. Christoph Schwartz
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  2. Andreas Grillhösl
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  3. Christian Schichor
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  4. Bogdana Suchorska
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  6. Jörg-Christian Tonn
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Correspondence to Christoph Schwartz.

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Schwartz, C., Grillhösl, A., Schichor, C. et al. Symptomatic cavernous malformations of the brainstem: functional outcome after microsurgical resection. J Neurol 260, 2815–2822 (2013). https://doi.org/10.1007/s00415-013-7071-3

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  • DOI: https://doi.org/10.1007/s00415-013-7071-3

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