Authors: R G Sola P Pulido J Pastor M Ochoa J Castedo
Publish Date: 2007/04/05
Volume: 149, Issue: 5, Pages: 463-470
Abstract
Introduction and objectives Cavernous malformations CM at the level of the brainstem continue to present a challenge in therapeutic terms and are an important source of controversy Here we present our experience and the results obtained by adopting surgical treatmentMaterials and methods The results of a consecutive series of 17 patients were studied The surgical intervention was designed after 1 A neurological examination 2 MRI and cerebral angiography 3 Correlation with anatomical brainstem maps The surgical intervention was approached from the most damaged zone or through a zone which was functionally least importantResults Complete extirpation was achieved in 15 patients without mortality In a few patients the surgical intervention temporarily aggravated the prior lesion of the cranial nerves 2/17 or damage new sensory tracts 2/17 The functional postoperative recovery was good in terms of consciousness 4/5 cranial nerves 11/17 the pyramidal tract 3/5 and the cerebellum 2/4 Of the patients that were operated 14 of 17 returned to their professional activitiesConclusions The results of surgery can surpass the morbidity–mortality of the natural history or treatment with radiosurgery There is a clear consensus in recommending surgical intervention for CMs that are superficially located in young patients and in those with a risk of further bleeding It is probably best that the surgery is performed during the subacute period when the MRI offers a clear image confirming the presence of the CM
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