Early surgery for brainstem cavernomas
Détails
ID Serval
serval:BIB_1AF9D040E1AF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Early surgery for brainstem cavernomas
Périodique
Acta Neurochirurgica
ISSN
0001-6268 (Print)
Statut éditorial
Publié
Date de publication
04/2006
Volume
148
Numéro
4
Pages
405-14
Notes
Journal Article --- Old month value: Apr
Résumé
BACKGROUND: The purpose was to review our experience with the surgical management of brainstem cavernomas (BSCs) and especially the impact of the surgical timing on the clinical outcome. METHOD: We retrospectively reviewed 22 patients harboring a BSC, who underwent 23 procedures. FINDINGS: Surgery was carried out during the early stage after the last haemorrhage, with a mean delay of 21.6 days (range 4-90 days). Sixteen procedures were performed after a first bleeding event while seven after multiple bleedings. Complete resection was achieved in 19 patients (86.4%). Early after surgery, 12 patients (52.2%) improved neurologically, 5 (21.7%) were stable and 6 (26.1%) worsened. New postoperative deficits were noted after 9 procedures (39.1%). Statistically significant factors for postoperative aggravation were: late surgery (P = 0.046) and multiple bleedings (P = 0.043). No patient operated on within the first 19 days after bleeding did worsen (n = 11), as opposed to 6 out of 12 who did when operated on later. After a mean follow-up of 44.9 months, 20 patients (90.9%) were improved, 1 patient (4.6%) was worse and 1 patient was lost to follow-up (4.6%), after reoperation for rebleeding of a previously completely resected cavernoma. Late morbidity was reduced to 8.6%. The mean Glasgow Outcome Scale (GOS) at the end of the follow-up period was 4.24, compared to a mean preoperative GOS of 3.22 (P<0.001). Complete neurological recovery of motor deficits, sensory disturbances, cranial nerves (CNs), internuclear ophtalmoplegia and cerebellar dysfunction were respectively 41.7%, 38.5%, 52.6%, 60.0% and 58.3%. Among the most affected CNs: CN 3, CN 5 and CN 7 were more prone to completely recover, respectively in 60.0%, 70.0% and 69.2%. CONCLUSIONS: Surgical removal of BSCs is feasible in experienced hands with acceptable morbidity and good outcome. Early surgery and single bleeding were associated with better surgical results.
Mots-clé
Adolescent
Adult
Aged
Blood Vessels/pathology/physiopathology
Brain Stem/blood supply/*pathology/*surgery
Child
Consciousness Disorders/etiology/physiopathology/surgery
Cranial Nerve Diseases/etiology/physiopathology/surgery
Disease Progression
Female
Hemangioma, Cavernous, Central Nervous
System/diagnosis/physiopathology/*surgery
Humans
Male
Middle Aged
Neurosurgical Procedures/adverse effects/methods/*statistics & numerical
data
Postoperative Complications/etiology/physiopathology/prevention & control
Postoperative Hemorrhage/prevention & control
Recovery of Function/physiology
Recurrence
Reoperation/statistics & numerical data
Retrospective Studies
Risk Assessment
Time Factors
Treatment Outcome
Vascular Surgical Procedures/adverse effects/methods/*statistics &
numerical data
Pubmed
Web of science
Création de la notice
25/01/2008 14:10
Dernière modification de la notice
20/08/2019 13:51