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Acta Neurochirurgica
Published in: Acta Neurochirurgica 10/2018

01-10-2018 | Original Article - Neurosurgery general

Treatment of cavernous malformations in supratentorial eloquent areas: experience after 10 years of patient-tailored surgical protocol

Authors: Jose L. Sanmillan, Pablo Lopez-Ojeda, Isabel Fernández-Conejero, Alejandro Fernández-Coello, Gerard Plans, Yara Ali-Ciurana, Andreu Gabarrós

Published in: Acta Neurochirurgica | Issue 10/2018

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Abstract

Background

Eloquent area surgery has become safer with the development of intraoperative neurophysiological monitoring and brain mapping techniques. However, the usefulness of intraoperative electric brain stimulation techniques applied to the management and surgical treatment of cavernous malformations in supratentorial eloquent areas is still not proven. With this study, we aim to describe our experience with the use of a tailored functional approach to treat cavernous malformations in supratentorial eloquent areas.

Methods

Twenty patients harboring cavernous malformations located in supratentorial eloquent areas were surgically treated. Individualized functional approach, using intraoperative brain mapping and/or neurophysiological monitoring, was utilized in each case. Eleven patients underwent surgery under awake conditions; meanwhile, nine patients underwent asleep surgery.

Results

Total resection was achieved in 19 cases (95%). In one patient, the resection was not possible due to high motor functional parenchyma surrounding the lesion tested by direct cortical stimulation. Ten (50%) patients presented transient neurological worsening. All of them achieved total neurological recovery within the first year of follow-up. Among the patients who presented seizures, 85% achieved seizure-free status during follow-up. No major complications occurred.

Conclusions

Intraoperative electric brain stimulation techniques applied by a trained multidisciplinary team provide a valuable aid for the treatment of certain cavernous malformations. Our results suggest that tailored functional approach could help surgeons in adapting surgical strategies to prevent patients’ permanent neurological damage.
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Metadata
Title
Treatment of cavernous malformations in supratentorial eloquent areas: experience after 10 years of patient-tailored surgical protocol
Authors
Jose L. Sanmillan
Pablo Lopez-Ojeda
Isabel Fernández-Conejero
Alejandro Fernández-Coello
Gerard Plans
Yara Ali-Ciurana
Andreu Gabarrós
Publication date
01-10-2018
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 10/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-018-3644-3

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