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Surgical treatment of brainstem cavernous malformation
J Korean Skull Base Soc 2017;12(1):10-16
Published online May 30, 2017
© 2017 Korean Skull Base Society.

Ju-Hyung Lee1 , MD, Sun-Yong Son1 , MD, Sung-Han Oh1 , MD, PhD,Je-Beom Hong2, MD, Han-Kyu Kim2, MD, PhD

1Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, South Korea 2Department of Neurosurgery, CHA Bundang Medical Center, Seongnam, South Korea
Abstract
Purpose : The surgical excision is considered as the gold standard of cavernous malformation(CM) treatment. However, due to the high incidence of surgical morbidity, many surgeons feel very stressful for this disease. The authors reviewed their surgical cases of brainstem cavernous malformation in search of the safe surgical strategy for this dreadful disease. Materials and methods : From Sep. 2014 to Jul. 2016, total 14 cases of brainstem malformation were surgically resected using skull base technique with the use of intraoperative neuronavigation and neurophysiological monitoring. The clinical profile, radiological findings, surgical records were reviewed. The surgical videos were reviewed and the microsurgical findings were thoroughly investigated to identify the most efficient surgical techniques. Results : There were 6 women and 8 men aged 35.1 years old in average (11 - 58 years). And there are 1 case of midbrain CM, 11 cases of pontine CM, 2 cases of medulla oblongata CM. The surgical approaches were 8 telovelar approaches, 4 petrosal approaches, 1 far lateral approach and 1 midline suboccipital approach. The CMs were totally removed in all 14 cases and one case of them required the reoperation. The postoperative neurologic deficits include 5 cases of facial palsy, 6 cases of 6th n. palsy, 2 cases of motor deficit, 5 cases of sensory disturbance. Cerebrospinal fluid (CSF) leakage was developed in 2 cases. There was no mortality. Conclusion : The surgery of brainstem CM is difficult because of their critical location and surrounding neurovascular structures. However, brainstem CM can be surgically removed through the safe entry point using meticulous skull base technique.
Keywords : cavernous malformation, brain stem, surgical approach, skull base


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