Surgical Approaches for Brainstem Cavernous Angiomas

Abstract

Surgical resection is indicated when patients with brainstem cavernous hemangioma present with repeated hemorrhage and exacerbation of neurological symptoms. Achieving maximum excision of the lesions through a small incision on the brainstem and functional preservation are required in such cases.

Since 2011, the authors have experienced surgical resection of 13 brainstem cavernous hemangiomas. The trans-fourth ventricular approach was applied for 7 cases (6 females, mean age 53.8 years), including 5 pontine and 2 medullar lesions. The surgical approach was determined by the “2-point method”. This method connects the lesion's center and the point where the lesion was closest to the surface. The nerve function was protected during the operations with the aid of neuromonitoring. In addition, an angled neuroendoscope was used in 4 cases in the latter period to secure a different visual axis from that of the microscope. The lesions were completely removed except in 1 case.

The trans-fourth ventricular approach is an established surgical corridor for the cavernous hemangioma located in the dorsal pons and the medulla. Since surgeons need to remove the lesion through a small opening of the brainstem, neuromonitoring and adjunctive use of the endoscope were helpful. Selecting an appropriate surgical approach for the brainstem lesion is essential to achieve a safe and maximum degree of brainstem cavernous angiomas resections.