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Instituto Nacional de Neurología y Neurocirugía

2006, Number 4

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Arch Neurocien 2006; 11 (4)

Surgical approaches to cavernomas of the brainstem. Surgical experience at the National Institute of neurology and Neurosurgery “manuel Velasco Suarez” Mexico City, and analysis of the literature

García PC, Nathal E

Language: Spanish
References: 31
Page: 258-270
PDF size: 214.45 Kb.


ABSTRACT

Cavernous angiomas,cavernomas or occult vascular malformations, belong to the group of vascular malformations described originally by Mc Cormick. They represent between 5-13% of the total intracranial vascular malformations. Of these, between 15-35% are located at the brainstem from the mesencephalon to the medulla oblongata. Cavernomas of the brainstem are considered frequently out of surgical treatment due to the apparent complexity to reach them safetly. This fact has induced a phenomena of inapropiate alternatives such the radiosurgery or endovascular therapy. The skull base approaches, have demostrated a great advance in exposure and surgical treatment of cavernomas at this location, regardless of their position in the brainstem. In this paper, we report our experience with 6 patients harboring a brainstem cavernoma that underwent surgical treatment at the National Institute of Neurology and Neurosurgery «Manuel Velasco Suárez» – Mexico City. In all cases the excision of the cavernoma was accomplished without adding neurological deficits. There was no mortality in our series. We also made an analysis from the literature about the surgical results in different series, and the most frequently used surgical approaches. In conclusion, we can say that surgery remains as the most effective method for radical treatment of brainstem cavernomas. The most important points to consider are the location (mesencephalon, pontis or medulla oblongata), position inside the brainstem (anterior, medium, lateral or posterior) and selection of the surgical approach to expose the shortest way from the surface to the lesion avoiding eloquent neural structures (nucleus of craneal nerves, long tracts of conexion fibers). Radiosurgery remains controversial as therapeutic alternative due to the inability to dissapear the lesions, even when it is claimed that reduces at long term the risk of bleeding.


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