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Journal of Korean Neurosurgical Society 2005;37(3): 173-178.
Treatment of Brainstem Cavernous Malformation: Treatment Indication, Technical Consideration, and Results.
Sang Bok Lee, Jung Il Lee, Jong Soo Kim, Seung Chyul Hong, Kwan Park
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jilee@smc.samsung.co.kr
The goal of this study is to provide the clinical data of patients with brainstem cavernous hemangiomas after treatment with microsurgery or radiosurgery after conducting a retrospective analysis of 21 patients at one institution.
Twenty one patients with brainstem cavernous hemangiomas were treated at the authors' institution between 1995 and 2004 and clinical analysis was performed by retrospective review of medical records and neuroimaging examinations. Thirteen patients underwent microsurgical resection and radiosurgery was performed as an initial treatment in 9 patients. RESULTS: Radical excision was achieved in 12 among 13 patients and transitory neurological deterioration or new neurological deficit developed during the immediate postoperative period in 7 (54%). The final outcomes at 5-70 months after surgery were improved in 11 patients (85%) and worsened in 2 patients (15%) compared with the preoperative state. Radiosurgery was performed in 9 patients. During the follow up period from 5 to 70 months there was neurological improvement in 3 patients, no significant change in 3 and deterioration in 3 patients. Two patients developed rebleeding at 5 months, 60 months respectively after radiosurgery. CONCLUSION: Microsurgery for symptomatic cavernous hemangioma of brainstem can be performed with acceptable morbidity. Fatal complication is rare with careful selection of the optimal operative approach in well selected patients. Radiosurgery is an effective alternative for the lesions which are not accessible by surgical approach, however, there is still a possibility of rebleeding over a long period after radiosurgical treatment and microsurgery should be considered as a treatment with priority for the majority of cases.
Key Words: Cavernous hemangioma; Brainstem; Microsurgery; Radiosurgery
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