Cavernous malformations of the brain stem - the clinical features and surgical approaches

Abstract

Introduction. Cavernous malformations localized in the brain stem are considered as a separate entity in relation to other intracranial cavernoma. Clinical presentation is specific in terms of focal neurologic deficit, they show aggressive biological behavior and unfavorable clinical course, whereas localization in the brain stem naturally represents the largest surgical problem and challenge and significantly higher operational risk. Results. We report a series of 10 patients with brainstem cavernoma, operated at the Department of Neurosurgery, Clinical Center of Serbia in the period of 2008-2012. In cavernous lesions of the dorsal pons and upper cerebellar peduncul we used the approach through the fourth ventricule, in the laterally localized pontine cavernoma we used the cerebellopontine angle approach, in the cavernoma localized in the central midbrain tegmental area was used supreacerebellar infratentorially approach. Conclusion. Surgical removal of the brainstem cavernoma is absolutely expedient both from the standpoint of preventing recurrent and debilitating hemorrhage and in terms of recovery of neurologic deficit. In patients with disturbed vital functions, the evacuation of the hematoma and removal of the malformation eliminate compression of effects on vital structures of the brain stem.