Surgery Approaches to Brainstem Cavernous Malformations

BACKGROUND AND PURPOSE: To summarize our experience in surgery approach to brainstem cavernous malformation (BSCM). METHODS: A review of 23 consecutive patients with BSCM receiving surgical resection in our center between July of 2003 and June of 2014 was performed. RESULTS: Suboccipital approach, retrosigmoid approach, infratentorial-supracerebellar approach, Poppen approach, pterional approach, Kawase approach, and interhemispheric transcallosal-third ventrical approach were applied, of which the last 2 approaches being firstly reported in BSCM surgery. Gross total resection was achieved in 22 patients, whereas subtotal resection in 1. Neurologic function was improved in 15 patients, unchanged in 7 patients, and deteriorated in 1 patient. During a mean follow-up of 3.5 years, no recurrence occurred. CONCLUSIONS: Proper surgery approach is important to assure total resection, protect normal vital structures, and avoid recurrence.