Management and Surgical Outcomes of Brain Stem Cavernomas: A Nine-Year Retrospective Analysis of 20 Cases

Background: Brain stem cavernomas (BSCs) are rare vascular malformations, accounting for 8-22% of intracranial cavernoma lesions. These lesions can cause severe neurological deficits and life-threatening hemorrhages, making their management challenging. Aimes: This study retrospectively evaluates the clinical presentation, surgical management, and outcomes of patients with BSCs to improve clinical strategies and patient care. Methods: This retrospective study analyzed 20 patients with BSCs treated at Loghman Hakim Hospital, Tehran, Iran, from 2014 to 2023. Clinical data were collected from medical records, including demographic information, clinical presentations, imaging findings, and surgical intervention details. Lesion characteristics were documented and classified. Surgical approaches were based on lesion location and proximity to critical structures. Outcomes were assessed using the Modified Rankin Scale (MRS), resolution of cranial nerve (CN) palsies, incidence of rebleeding, and postoperative complications. Descriptive statistics was used to summarize patient characteristics and outcomes. Results: The study included 20 patients (mean age 34.25 years; 55% male) with a mean follow-up of 37.1 months. The most common presentation was headache (30%), followed by hemiparesis (15%) and cerebellar symptoms (70%). Prior hemorrhage occurred in 75% of cases. Lesions were predominantly deep-seated (60%) and averaged 30 mm in diameter. Postoperative outcomes showed improvement in MRS scores in 75% of cases, with CN palsies resolving in 20%. Rebleeding occurred in 20% of patients, and other complications included ataxia and gait disturbances. Surgical management, primarily through suboccipital telovelar and retrosigmoid approaches, significantly improved neurological function and quality of life. Conclusion: Surgical intervention for symptomatic BSCs, particularly through suboccipital telovelar and retrosigmoid approaches, leads to favorable clinical outcomes. Accurate patient selection, preoperative planning, and meticulous microsurgical techniques are crucial for optimizing results. Future research should focus on refining surgical approaches and exploring genetic and molecular aspects of BSCs to enhance management strategies and patient outcomes.