Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Adler, E.
Therapeutic options in brainstem cavernous malformations
A retrospective analysis of 26 patients treated at the Department of Neurosurgery in Graz
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Mahdy Ali Kariem
- Mokry Michael
- Altmetrics:
- Abstract:
- Background: Brainstem cavernous malformations are relatively rare and once considered inoperable, nowadays they are surgically treatable, with encouraging results. Nevertheless, there are remaining questions concerning these lesions. Therefore, every report contributes to the exploration of this pathology. Objective: The aim of this retrospective analysis was to evaluate the efficacy of surgical treatment, based on the pre- and postoperative rates of morbidity and to identify predictors which influence the surgical outcome. Methods: The medical histories from 26 patients of the Neurosurgical Department of the Medical University of Graz were retrospectively reviewed. We analyzed: patient demographics, pre- and postoperative neurological status using modified Rankin Scale scores and Glasgow Outcome Scale sores, lesion characteristics and surgical approaches. A descriptive statistical analysis was performed. We used a Wilcoxon test to compare the pre- and postoperative scores and a Mann-Whitney Test to investigate the association of the outcome with the size of the lesion. Results: Ages ranged from 16 to 71 years (mean, 43,1 years; median, 40 years). 11 (42,3%) patients had a single and 15 (57,7%) patients had multiple hemorrhagic events. The time from the last hemorrhagic event to surgery was evaluated with a median of 28 days and a mean of 41 days. 14 (53,9%) cavernomas were located in the pons, 6 (23,1%) in the medulla oblongata and 6 (23,1%) in the midbrain. The size of the lesions ranged from 0,231 to 7,9 cm3. Total resection was achieved in 18 (69,2%), subtotal in 1 (3,8%), partial in 4 patients (15,4%), in 1 (3,85%) patient the cavernoma was inaccessible, 1 (3,85%) patient was treated radiosurgically and 1 (3,85%) patient was treated conservatively. Complications occurred in 6 cases (25%), which involved liquor fistula in four patients and rhinoliquorrhea in two patients. The Wilcoxon-test showed that the neurological status improved significantly (p=0,006) after resection. The Mann-Whitney Test did not show a statistically significant correlation (p=0,698). However, the graphical illustration showed a correlation of larger size with unfavorable outcome. Conclusion: Surgical resection is the first choice of treatment, it should be performed in the subacute phase and total resection of the lesion is essential.