SURGERY OF BRAIN STEM CAVERNOUSES MALFORMATION
Vyacheslav Vladimirovich STUPAK1, Shalinder AUL2, Alexander Gennadievich BOBYLEV2, Maxim Vladimirovich KUTSENKO2, Dmitriy Alexandrovich DENTSEL2, Timur Mosambekovich SHOGUNBEKOV2, Vitaliy Mikhaylovich BON2, Andrey Mikhaylovich GAZEEV2, Alexander Evgenievich SIMONOVICH1, Sergey Borisovich TSVETOVSKIY1
1Novosibirsk Research Institute of Traumatology and Orthopedics n.a. Ya.L. Tsivyan of Minzdrav of Russia
VStupak@niito.ru
2State Novosibirsk Regional Clinical Hospital
aulbarnaul@mail.ru
Keywords: кавернома, кавернозная мальформация ствола головного мозга, кавернозная ангиома, нейрохирургия, нейрофизиологический мониторинг
Abstract
Cavernous malformations
(CM), also known as cavernous angiomas or cavernomas, are benign
vascular hamartomas having a sinusoidal type of wall structure.CM occurs
in the brain stem with a frequency of 9-35 % of cases. They are most
often localized in the brain stem, have a higher risk of hemorrhage
compared to supratentorial. After the primary hemorrhage, the risks of
recurrent hemorrhages are very high. CM located in the brain stem has
not always been subjected to surgical treatment. Conservative treatment
was recommended for most patients. At the same time, according to the
literature data, mortality reached 20 %, and during radiosurgery up to
8.3 % with recurrence of hemorrhage up to 59 %. The aim of the study was
to evaluate the results of surgical treatment of patients with
cavernomas of the brain stem. Materials and methods. the study included
16 patients who had hemorrhages in different parts of the brain stem.
There were 12 males (75 %) and 4 females (25 %). Indications for
surgical treatment were: presence of subacute hematoma, recurrent
hemorrhage and progressive symptoms of brain stem damage. All patients
were operated using modern methods of microsurgery. Neurophysiological
monitoring was performed intraoperatively. Statistical processing was
carried out with the program Statistica (version 10). Results. There was
no operational mortality. At discharge, patients were assessed on the
Rankin scale. Good functional outcomes were achieved in 87.8 % of cases
(Rankin 1 - 43.8 %, Rankin 2 - 31.5 %, Rankin 3 - 12.5 %). Summary.
Symptomatic malformations of the brain stem are subject to surgical
removal when they are anatomically accessible. The use of modern methods
of neuroimaging, adequate, sparing surgical approaches, microsurgical
techniques for removing the cavernous brain stem, allows us to achieve
good functional results in the operated patients, in the absence of
postoperative mortality.
|
