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01-11-2012 | Technical Note

Anterior subtemporal approach for posterolateral brainstem cavernomas: report of ten cases

Authors: Giovanni Sabatino, Luigi Rigante, Enrico Marchese, Alessio Albanese, Giuseppe Esposito, Gennaro Capone, Giulio Maira

Published in: Acta Neurochirurgica | Issue 11/2012

Abstract

Background

The neuronavigation-assisted anterior subtemporal approach is proposed in this article as an alternative to surgery of posterolateral brainstem cavernomas. Brainstem cavernomas represent a neurosurgical challenge because of the high morbidity and mortality rate related to their surgical removal. Several nerve nuclei, ascending and descending fibers make this region at high risk of serious postoperative deficits.

Methods

Between 1998 and 2010, 24 patients underwent surgical removal of brainstem cavernomas in our institution. Ten of these patients presented a cavernous malformation in the posterolateral region of the brainstem and underwent surgical removal by means of a neuronavigation-assisted anterior subtemporal approach.

Results

Lesion removal was complete for all patients. There were no cases of surgery-related death. Neurological status improved or remained unchanged after surgery in all cases. All patients presented good outcomes at 12 to 154 months' follow-up (mean 70 months; GOS = 5 in 8/10 patients, 4 in 2/10 patients; mRS = 0–1 in all patients). Only one patient presented transient confusion, aphasia and seizures related to temporal lobe swelling, which resolved completely within a few days. One patient developed cranial nerve III palsy and left hemiparesis with gradual recovery.

Conclusions

This approach represents a valid alternative to the “more classical” approaches for the surgery of posterolateral cavernomas of the pontomesenchephalic junction reaching the tentorial incisura, reducing the risk of damaging the vein of Labbé, temporal lobe swelling, cerebellar swelling, ophtalmoparesis, fourth ventricle cranial nerve nuclei lesions. Skeletonization of sigmoidal sinus provides with good outcomes, low morbidity and mortality.

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Abla AA, Lekovic GP, Turner JD, de Oliveira JG, Porter R, Spetzler RF (2011) Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. Neurosurgery 68:403–414PubMedCrossRef

Abla AA, Turner JD, Mitha AP, Lekovic G, Spetzler RF (2010) Surgical approaches to brainstem cavernous malformations. Neurosurg Focus 29(3):E8, ReviewPubMedCrossRef

Bruneau M, Bijlenga P, Reverdin A, Rilliet B, Regli L, Villemure JG, Porchet F, de Tribolet N (2006) Early surgery for brainstem cavernomas. Acta Neurochir (Wien) 148(4):405–414CrossRef

Cantore G, Missori P, Santoro A (1999) Cavernous angiomas of the brain stem. Intra-axial anatomical pitfalls and surgical strategies. Surg Neurol 52(1):84–93, discussion 93-94PubMedCrossRef

Clatterbuck RE, Bernardo A, Spetzler RF (2003) Discovering the novel surgical approach. Clin Neurosurg 50:36–44PubMed

Ferroli P, Sinisi M, Franzini A, Giombini S, Solero CL, Broggi G (2005) Brainstem cavernomas: long-term results of microsurgical resection in 52 patients. Neurosurg 56(6):1203–1212, discussion 1212-1214CrossRef

François P, Ben Ismail M, Hamel O, Bataille B, Jan M, Velut S (2010) Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas. Acta Neurochir (Wien) 152(8):1321–1329. doi:1321, discussion 1329CrossRef

Giliberto G, Lanzino DJ, Diehn FE, Factor D, Flemming KD, Lanzino G (2010) Brainstem cavernous malformations: anatomical, clinical, and surgical considerations. Neurosurg Focus 29(3):E9PubMedCrossRef

Goel A (1996) Basal extension of craniotomy for subtemporal middle fossa approach. Br J Neurosurg 10(6):589–591PubMedCrossRef

10.

Greenberg MS (2006) Cavernous malformation. In: Greenberg MS (ed) Handbook of Neurosurgery, sixth edn. Thieme, New York, pp 841–843

11.

Hauck EF, Barnett SL, White JA, Samson D (2009) Symptomatic brainstem cavernomas. Neurosurgery 64(1):61–70, discussion 70-71PubMedCrossRef

12.

Hauck EF, Barnett SL, White JA, Samson D (2010) The presigmoid approach to anterolateral pontine cavernomas. Clinical article. J Neurosurg 113(4):701–708PubMedCrossRef

13.

Li H, Ju Y, Cai BW, Chen J, You C, Hui XH (2009) Experience of microsurgical treatment of brainstem cavernomas: report of 37 cases. Neurol India 57(3):269–273PubMedCrossRef

14.

Mathiesen T, Edner G, Kihlström L (2003) Deep and brainstem cavernomas: a consecutive 8-year series. J Neurosurg 99(1):31–37PubMedCrossRef

15.

Ohue S, Fukushima T, Kumon Y, Ohnishi T, Friedman AH (2010) Surgical management of brainstem cavernomas: selection of approaches and microsurgical techniques. Neurosurg Rev 33(3):315–322, discussion 323-324PubMedCrossRef

16.

Pechstein U, Zentner J, Van Roost D, Schramm J (1997) Surgical management of brain-stem cavernomas. Neurosurg Rev 20(2):87–93PubMedCrossRef

17.

Porter RW, Detwiler PW, Spetzler RF, Lawton MT, Baskin JJ, Derksen PT, Zabramski JM (1999) Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg 90(1):50–58PubMedCrossRef

18.

Ramina R, Mattei TA, de Aguiar PH, Meneses MS, Ferraz VR, Aires R, Kirchhoff DF, de Carvalho KD (2011) Surgical management of brainstem cavernous malformations. Neurol Sci 32(6):1013–1028PubMedCrossRef

19.

Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2(5):200–215PubMed

20.

Recalde RJ, Figueiredo EG, de Oliveira E (2008) Microsurgical anatomy of the safe entry zones on the anterolateral brainstem related to surgical approaches to cavernous malformations. Neurosurgery 62(3 Suppl 1):9–15, discussion 15-17PubMedCrossRef

21.

Rigamonti D, Hadley MN, Drayer BP, Johnson PC, Hoenig-Rigamonti K, Knight JT, Spetzler RF (1988) Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 319(6):343–347PubMedCrossRef

22.

Samii M, Eghbal R, Carvalho GA, Matthies C (2001) Surgical management of brainstem cavernomas. J Neurosurg 95(5):825–832PubMedCrossRef

23.

Sandalcioglu IE, Wiedemayer H, Secer S, Asgari S, Stolke D (2002) Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results. J Neurol Neurosurg Psychiatry 72(3):351–355PubMedCrossRef

24.

Smith ER, Chapman PH, Ogilvy CS (2003) Far posterior subtemporal approach to the dorsolateral brainstem and tentorial ring: technique and clinical experience. Neurosurgery 52(2):364–368, discussion 368-369PubMedCrossRef

25.

Steňo J, Bízik I, Steňová J, Timárová G (2011) Subtemporal transtentorial resection of cavernous malformations involving the pyramidal tract in the upper pons and mesencephalon. Acta Neurochir (Wien) 153(10):1955–1962, discussion 1962CrossRef

26.

van Swieten J, Koudstaal P, Visser M, Schouten HJ, van Gijn J (1998) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607CrossRef

27.

Viñas FC, Gordon V, Guthikonda M, Diaz FG (2002) Surgical management of cavernous malformations of the brainstem. Neurol Res 24(1):61–72PubMedCrossRef

28.

Wang CC, Liu A, Zhang JT, Sun B, Zhao YL (2003) Surgical management of brain-stem cavernous malformations: report of 137 cases. Surg Neurol 59(6):444–454, discussion 454PubMedCrossRef

Title: Anterior subtemporal approach for posterolateral brainstem cavernomas: report of ten cases
Authors: Giovanni Sabatino
Luigi Rigante
Enrico Marchese
Alessio Albanese
Giuseppe Esposito
Gennaro Capone
Giulio Maira
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Acta Neurochirurgica / Issue 11/2012
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-012-1496-9

At a glance: The STEP trials

Springer Medicine

Anterior subtemporal approach for posterolateral brainstem cavernomas: report of ten cases

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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