Surgical treatment of brain stem cavernoma: Current approaches

Results of our series of 10 operated patients who had cavernous malformation of the brain stem, in accordance with the findings of other authors, have confirmed that surgical removal of cavernomas is an absolutely appropriate approach as regards the prevention of repeated and disabling hemorrhages, also from the point of view of the recovery of the neurological deficit. In patients with disturbed vital functions (breathing, swallowing) evacuation of hematomas and removal of the malformation eliminate life endangering compressive effect on the vital structures of the brain stem. It is not disputable that patients with superficially localized cavernomas and progressing neurological deficit should be subjected to surgical treatment. In cases of deep lying lesions that are covered by a considerable layer of nervous parenchyma, it is indispensable to have a very careful preoperative planning of a safe entry into the brain stem, without damage to the vital functional structures. In case of a complete neurological recovery after a single hemorrhagic episode, the decision to perform surgery is delicate and demands individual appraisal of each patient. As regards the procedure with incidentally found and clinically asymptomatic lesions, regardless of the MR-signs of hemorrhage in the form of the hemosiderin ring around the lesion, we support the view of those authors who think that such lesions should not be operated but should be subjected to clinical treatment and MR with periodical MR check-ups.