Skip to main content

Advertisement

SpringerLink
Log in

Surgical managements and patient outcomes after severe hemorrhagic events from brainstem cavernous malformations

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

To evaluate the surgical outcomes and predictors and the impact of surgical timing of patients who suffered a severe hemorrhagic event from brainstem cavernous malformations (CMs). The clinical data of all patients who underwent surgical treatment after a severe bleeding ictus from brainstem CMs between 2011 and 2017 were retrospectively reviewed. The study population consisted of 61 surgical patients (40, 65.6% female). Surgical times of < 3 weeks, ≥ 3–8 weeks, and > 8 weeks since the last bleeding ictus were observed in 23 (37.7%), 24 (39.3%), and 14 (23.0%) patients, respectively. The mean modified Rankin scale (mRS) score evaluated on admission was 4.2. With a mean follow-up of 39.8 months, 39 patients (63.9%) had a favorable outcome (mRS ≤ 2), and the mean mRS score was 2.3. The logistic regression analysis identified age, having disrupted consciousness and/or respiration, and time to surgery from last hemorrhage as significant predictors of long-term outcome. In particular, patients with surgery performed during the acute period (< 3 weeks, P = 0.06) or chronic period (> 8 weeks, P = 0.01) tended to have poor outcomes when compared with those with surgery during the subacute period (≥ 3–8 weeks). Favorable neurological outcomes can be achieved in patients who were surgically treated after a severe hemorrhagic ictus from brainstem CMs, and operation during subacute hemorrhage (≥ 3–8 weeks) could benefit these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abla AA, Lekovic GP, Turner JD, de Oliveira JG, Porter R, Spetzler RF (2011) Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients. Neurosurgery 68:403–414 discussion 414-405

    Article  Google Scholar 

  2. Abla AA, Turner JD, Mitha AP, Lekovic G, Spetzler RF (2010) Surgical approaches to brainstem cavernous malformations. Neurosurg Focus 29:E8

    Article  Google Scholar 

  3. Al-Shahi Salman R, Hall JM, Horne MA, Moultrie F, Josephson CB, Bhattacharya JJ, Counsell CE, Murray GD, Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP (2012) Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study. Lancet Neurol 11:217–224

    Article  Google Scholar 

  4. Cavalcanti DD, Preul MC, Kalani MY, Spetzler RF (2016) Microsurgical anatomy of safe entry zones to the brainstem. J Neurosurg 124:1359–1376

    Article  Google Scholar 

  5. Chen L, Zhao Y, Zhou L, Zhu W, Pan Z, Mao Y (2011) Surgical strategies in treating brainstem cavernous malformations. Neurosurgery 68:609–621

    Article  Google Scholar 

  6. Dammann P, Wrede K, Jabbarli R, Müller O, Mönninghoff C, Forsting M, Sure U (2017) Of bubbles and layers: which cerebral cavernous malformations are most difficult to dissect from surrounding eloquent brain tissue? Neurosurgery 81:498–503

    Article  Google Scholar 

  7. Garcia RM, Ivan ME, Lawton MT (2015) Brainstem cavernous malformations: surgical results in 104 patients and a proposed grading system to predict neurological outcomes. Neurosurgery 76:265–277 discussion 277-268

    Article  Google Scholar 

  8. Giliberto G, Lanzino DJ, Diehn FE, Factor D, Flemming KD, Lanzino G (2010) Brainstem cavernous malformations: anatomical, clinical, and surgical considerations. Neurosurg Focus 29:E9

    Article  Google Scholar 

  9. Gross BA, Batjer HH, Awad IA, Bendok BR, Du R (2013) Brainstem cavernous malformations: 1390 surgical cases from the literature. World Neurosurg 80:89–93

    Article  Google Scholar 

  10. Gross BA, Du R (2015) Cerebral cavernous malformations: natural history and clinical management. Expert Rev Neurother 15:771–777

    Article  CAS  Google Scholar 

  11. Kupersmith MJ, Kalish H, Epstein F, Yu G, Berenstein A, Woo H, Jafar J, Mandel G, De Lara F (2001) Natural history of brainstem cavernous malformations. Neurosurgery 48:47–53 discussion 53-44

    CAS  PubMed  Google Scholar 

  12. Li D, Hao SY, Lou XH, Tang J, Xiao XR, Wu Z, Zhang LW, Zhang JT (2014) Apnea as an uncommon preoperative manifestation of medulla cavernous malformation: surgical treatment and literature review. Br J Neurosurg 28:335–339

    Article  Google Scholar 

  13. Li D, Yang Y, Hao SY, Wang L, Tang J, Xiao XR, Zhou H, Jia GJ, Wu Z, Zhang LW, Zhang JT (2013) Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations. J Neurosurg 119:996–1008

    Article  Google Scholar 

  14. Nathal E, Patino-Rodriguez HM, Arauz A, Imam SS, Acosta E, Evins AI, Longo GM (2018) Risk factors for unfavorable outcomes in surgically treated brainstem cavernous malformations. World Neurosurg 111:e478–e484

    Article  Google Scholar 

  15. Pandey P, Westbroek EM, Gooderham PA, Steinberg GK (2013) Cavernous malformation of brainstem, thalamus, and basal ganglia: a series of 176 patients. Neurosurgery 72:573–589 discussion 588-579

    Article  Google Scholar 

  16. Perrini P, Lanzino G (2006) The association of venous developmental anomalies and cavernous malformations: pathophysiological, diagnostic, and surgical considerations. Neurosurg Focus 21:e5

    Article  Google Scholar 

  17. Petr O, Lanzino G (2015) Brainstem cavernous malformations. J Neurosurg Sci 59:271–282

    CAS  PubMed  Google Scholar 

  18. Rao GS, Ramesh VJ, Lalla RK (2005) Ventilatory management and weaning in a patient with central hypoventilation caused by a brainstem cavernoma. Acta Anaesthesiol Scand 49:1214–1217

    Article  CAS  Google Scholar 

  19. Samii M, Eghbal R, Carvalho GA, Matthies C (2001) Surgical management of brainstem cavernomas. J Neurosurg 95:825–832

    Article  CAS  Google Scholar 

  20. Silvestrelli G, Lanari A, Droghetti A (2012) Ventilatory disorders. Front Neurol Neurosci 30:90–93

    Article  Google Scholar 

  21. Steiger HJ, Hanggi D, Stummer W, Winkler PA (2006) Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions. J Neurosurg 104:38–46

    Article  Google Scholar 

  22. Tumturk A, Li Y, Turan Y, Cikla U, Iskandar BJ, Baskaya MK (2018) Emergency resection of brainstem cavernous malformations. J Neurosurg 128:1289–1296

    Article  Google Scholar 

  23. Xiao X, Zhang L, Wu Z, Zhang J, Jia G, Tang J, Meng G (2013) Surgical resection of large and giant petroclival meningiomas via a modified anterior transpetrous approach. Neurosurg Rev 36:587–594

    Article  Google Scholar 

  24. Xie MG, Xiao XR, Guo FZ, Zhang JT, Wu Z, Zhang LW (2018) Surgical management and functional outcomes of cavernous malformations involving the medulla oblongata. World Neurosurg 119:e643–e652

    Article  Google Scholar 

  25. Zaidi HA, Mooney MA, Levitt MR, Dru AB, Abla AA, Spetzler RF (2017) Impact of timing of intervention among 397 consecutively treated brainstem cavernous malformations. Neurosurgery 81:620–626

    PubMed  Google Scholar 

  26. Zhang S, Li H, Liu W, Hui X, You C (2016) Surgical treatment of hemorrhagic brainstem cavernous malformations. Neurol India 64:1210–1219

    Article  Google Scholar 

  27. Zhang S, Lin S, Hui X, Li H, You C (2017) Surgical treatment of cavernous malformations involving medulla oblongata. J Clin Neurosci 37:63–68

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China

    Sungel Xie, Shun-Wu Xiao & Ming-Xiang Xie

  2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Sungel Xie, Jun-Ting Zhang, Zhen Wu & Li-Wei Zhang

  3. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

    Xin-Ru Xiao

Authors
  1. Sungel Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xin-Ru Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shun-Wu Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ming-Xiang Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun-Ting Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li-Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li-Wei Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The Beijing Tiantan Hospital Research Ethics Committee approved the study.

Informed consent

Due to the retrospective nature of the report, informed consent was not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xie, S., Xiao, XR., Xiao, SW. et al. Surgical managements and patient outcomes after severe hemorrhagic events from brainstem cavernous malformations. Neurosurg Rev 44, 423–434 (2021). https://doi.org/10.1007/s10143-019-01230-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-019-01230-0

Keywords

Search

Navigation