Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic laser interstitial thermal therapy for brainstem cavernous malformations: two preliminary cases

  • Case Report - Vascular Neurosurgery - Arteriovenous malformation
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Brainstem cavernous malformations (CMs) often have high hemorrhage rates and significant posthemorrhage morbidity. The authors present two cases in which magnetic resonance thermography-guided laser interstitial therapy was used for treatment of pontine CMs after recurrent hemorrhage. Both patients showed significant symptomatic improvement and were hemorrhage-free at 12- and 6-month follow-up, respectively. Each had radiographic evidence of lesion involution on serial follow-up imaging. These early results demonstrate this treatment modality may be technically safe; however, larger case numbers and longer follow-up are needed to demonstrate efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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; discussion 414-415. https://doi.org/10.1227/NEU.0b013e3181ff9cde

    Article  PubMed  Google Scholar 

  2. Awad IA, Polster SP (2019) Cavernous angiomas: deconstructing a neurosurgical disease. J Neurosurg 131:1–13. https://doi.org/10.3171/2019.3.JNS181724

    Article  PubMed  PubMed Central  Google Scholar 

  3. Batra S, Lin D, Recinos PF, Zhang J, Rigamonti D (2009) Cavernous malformations: natural history, diagnosis and treatment. Nat Rev Neurol 5:659–670. https://doi.org/10.1038/nrneurol.2009.177

    Article  PubMed  Google Scholar 

  4. Fritschi JA, Reulen HJ, Spetzler RF, Zabramski JM (1994) Cavernous malformations of the brain stem. A review of 139 cases. Acta Neurochir 130:35–46. https://doi.org/10.1007/bf01405501

    Article  PubMed  Google Scholar 

  5. Garcia RM, Ivan ME, Lawton MT (2015) Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes. Neurosurgery 76:265–277; discussion 277-278. https://doi.org/10.1227/NEU.0000000000000602

    Article  PubMed  Google Scholar 

  6. Garrett M, Spetzler RF (2009) Surgical treatment of brainstem cavernous malformations. Surg Neurol 72(Suppl 2):S3–S9; discussion S9-10. https://doi.org/10.1016/j.surneu.2009.05.031

    Article  PubMed  Google Scholar 

  7. Gross BA, Batjer HH, Awad IA, Bendok BR, Du R (2013) Brainstem cavernous malformations: 1390 surgical cases from the literature. World Neurosurg 80:89–93. https://doi.org/10.1016/j.wneu.2012.04.002

    Article  PubMed  Google Scholar 

  8. Gross BA, Lin N, Du R, Day AL (2011) The natural history of intracranial cavernous malformations. Neurosurg Focus 30(6):E24. https://doi.org/10.3171/2011.3.FOCUS1165

    Article  PubMed  Google Scholar 

  9. Kamath AA, Friedman DD, Akbari SHA, Kim AH, Tao Y, Luo J, Leuthardt EC (2019) Glioblastoma treated with magnetic resonance imaging-guided laser interstitial thermal therapy: safety, efficacy, and outcomes. Neurosurgery 84:836–843. https://doi.org/10.1093/neuros/nyy375

    Article  PubMed  Google Scholar 

  10. Kondziolka D, Lunsford LD, Kestle JR (1995) The natural history of cerebral cavernous malformations. J Neurosurg 83:820–824. https://doi.org/10.3171/jns.1995.83.5.0820

    Article  PubMed  Google Scholar 

  11. Kupersmith MJ, Kalish H, Epstein F, Yu G, Berenstein A, Woo H, Jafar J, Mandel G, De Lara F (2001) Natural history of brainstem cavernous malformations. Neurosurgery 48:47–53; discussion 53-54. https://doi.org/10.1097/00006123-200101000-00007

    Article  PubMed  Google Scholar 

  12. Porter RW, Detwiler PW, Spetzler RF, Lawton MT, Baskin JJ, Derksen PT, Zabramski JM (1999) Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg 90:50–58. https://doi.org/10.3171/jns.1999.90.1.0050

    Article  PubMed  Google Scholar 

  13. Wang CC, Liu A, Zhang JT, Sun B, Zhao YL (2003) Surgical management of brain-stem cavernous malformations: report of 137 cases. Surg Neurol 59:444–454; discussion 454. https://doi.org/10.1016/s0090-3019(03)00187-3

    Article  PubMed  Google Scholar 

  14. Willie JT, Malcolm JG, Stern MA, Lowder LO, Neill SG, Cabaniss BT, Drane DL, Gross RE (2019) Safety and effectiveness of stereotactic laser ablation for epileptogenic cerebral cavernous malformations. Epilepsia 60:220–232. https://doi.org/10.1111/epi.14634

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zabramski JM, Wascher TM, Spetzler RF, Johnson B, Golfinos J, Drayer BP, Brown B, Rigamonti D, Brown G (1994) The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg 80:422–432. https://doi.org/10.3171/jns.1994.80.3.0422

    Article  PubMed  Google Scholar 

  16. Zimmerman RS, Spetzler RF, Lee KS, Zabramski JM, Hargraves RW (1991) Cavernous malformations of the brain stem. J Neurosurg 75:32–39. https://doi.org/10.3171/jns.1991.75.1.0032

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Kristin Kraus, MSc, for her assistance with preparation of this paper. We thank Kenneth Shunn from the Medtronic for the help in downloading the isotherm and LITT damage maps.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neurosciences Center, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA

    Nicholas T. Gamboa, Michael Karsy, Rajiv R. Iyer, Robert J. Bollo & Richard H. Schmidt

  2. Division of Pediatric Neurosurgery, Primary Children’s Hospital, University of Utah, Salt Lake City, UT, USA

    Rajiv R. Iyer & Robert J. Bollo

Authors
  1. Nicholas T. Gamboa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Karsy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajiv R. Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert J. Bollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard H. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Karsy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The patients consented to the procedure and the submission of the case report to the journal.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Vascular Neurosurgery - Arteriovenous malformation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gamboa, N.T., Karsy, M., Iyer, R.R. et al. Stereotactic laser interstitial thermal therapy for brainstem cavernous malformations: two preliminary cases. Acta Neurochir 162, 1771–1775 (2020). https://doi.org/10.1007/s00701-020-04316-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04316-7

Keywords

Search

Navigation