Abstract
We reviewed nine (consecutive) cases of brainstem cavernous malformations surgically treated in Okayama University Hospital between 1994 and 2011, and evaluated the surgical approach used for each lesion, its accessibility, and the pre- and post-operative neurological statuses. All cases that were referred for surgery had a pre-surgical history of progressive or persistent neurological deficits caused by repeated episodes of hemorrhage. Of our nine cases, four of the cavernous malformations were dorsal lesions, three were lateral, and two were ventral. The dorsal lesions were treated using a trans 4th ventricular approach, the lateral lesions were treated using a retrosigmoid approach, and the ventral lesions were treated using an anterior petrosal approach in one patent and a presigmoid approach in the other. Total removal was carried out in seven patients, partial removal in one, and cauterization in one patient. Long-term follow-ups (mean: 78.2 months) showed no recurrent hemorrhages, and the mean modified Rankin Stroke Scale was 1.7. These findings indicate that direct surgery for brain stem cavernous malformation can be successfully performed by appropriate selection of surgical approaches under careful monitoring. The brainstem cavernous malformations require a skull-base approach and additional techniques based on considerations of local anatomy and surrounding structures.
