Critically located cavernous malformations

Abstract

Introduction: The aim of this study was to evaluate the clinical results of patients who underwent resection with the aid of microsurgical techniques and stereotactic and image-guided surgery for critically located cavernous malformations which still represent a considerable surgical challenge due to the close proximity of vital and eloquent structures. Methods: Between 1997 and 2003,12 patients with critically located cavernous malformations (CMs) underwent surgical resections at Ankara University Hospital. CMs of the pons (n=3), medulla oblongata. (n=l), cavernous sinus (n=3), motor cortex (n=4) and the newly defined superior cerebellar peduncle (n=l) were treated using image-guidance and advanced microsurgical principles. Preoperative assessment was done with CT, MRI and angiography. Lesion locations, clinical presentations and outcome were analyzed. The surgical approach was chosen as lateral suboccipital (n = 4), parietal (n = 4), cranioorbitozygomatic (n = 3) and retrosigmoid (n = 1). Results: All CMs were readily identified and completely removed with no permanent morbidity and mortality. The immediate outcome after surgery was improved for 8 patients (66.6%). Long-term outcome was unchanged for one patient and a proved good surgical outcome for three patients, during the mean follow-up period. Discussion: Stereotactic methods together with image-guidance and microsurgical techniques allow the creation of most effective and safe corridors to access the CMs in eloquent regions with a minimization of tissue manipulation and low risk of permanent neurological deficit.