Surgical management of brain-stem cavernous XXXX : report of 137 cases.

@entity1 @entity548 @entity772 @entity600 @entity51 @entity1410 @entity528
BACKGROUND: With the improvement in neuroimaging and microsurgical techniques, brain stem cavernous @entity600 are no longer considered inoperable. Surgical indications for brainstem cavernoma are evolving, with better understanding of its natural history and decreasing surgical complications. METHODS: During 1986 through 1998, a series of 137 @entity1 (4 @entity1 each with two brain stem lesions, total number of lesions, 141) with brain stem cavernous @entity600 were treated microsurgically at Beijing Neurosurgery Institute. The age distribution, lesion location, and clinical presentations were analyzed. The @entity548 rate, surgical indications and microsurgical techniques were also discussed. RESULTS: In our series, 92 of 137 cases (67.2%) suffered more than one @entity548 . Female @entity1 had a higher risk of recurrent @entity548 than that of male @entity1 . Unlike cavernomas @entity600 from other locations, repeated @entity548 from brain stem @entity600 are much more common and usually lead to new @entity51 . Among all 137 surgically treated @entity1 , there was no operative mortality. Ninety-nine @entity1 (72.3%) either improved or remained clinically stable postoperatively. The size of the cavernoma/ @entity1410 does not necessarily correlate with the surgical result. While the acute @entity1410 can facilitate the surgical dissection, longer clinical history with @entity548 often makes total surgical resection difficult, partially because of the firmer capsule that may not shrink or collapse after @entity1410 is released. Pathologically those capsules were associated with more @entity528 , fibrous proliferation and even calcifications. During the follow-up period between 0.5 to 11 years in 129 cases, 115 @entity1 (89.2%) have been working, studying, or doing house work. Three @entity1 (2.3%) suffered recurrent @entity548 . CONCLUSIONS: Surgical indications of brain stem cavernoma include (1) progressive @entity51 ; (2) overt acute or subacute @entity548 on MRI either inside or outside cavernous @entity600 with mass effect; (3) cavernoma/ @entity1410 reaching brainstem surface (<2 mm brain tissue between cavernoma / @entity1410 and pial surface). Grave clinical presentations like @entity772 , respiratory, or cardiac instability are not surgical contraindications. Emergent surgical evacuation may lead to satisfactory outcome. @entity548 will worsen the pre-existing @entity51 and possibly make the surgical dissections more difficult. @entity1 with minimum, stable @entity51 and lesion/ @entity1410 that has not reached the brain stem surface should be followed conservatively.
