Microsurgical management of brainstem cavernous malformations: a 10-year single-surgeon experience.

BACKGROUND

This study primarily reports a single-surgeon microsurgical experience emphasizing anatomical considerations and operative strategies.

METHODS

We retrospectively reviewed 17 patients who underwent microsurgical resection of brainstem cavernous malformations at a single institution over ten years. Data included demographics, clinical presentation, lesion characteristics, surgical approach, and outcomes. Functional status was assessed using the modified Rankin Scale. The Lawton grading system was applied for preoperative stratification.

RESULTS

Gross total resection was achieved in the majority of cases. Twelve of 17 patients (70.6%) developed no new neurological deficits, and most postoperative deficits were transient. At last follow-up, 10 patients (58.8%) achieved functional independence (modified Rankin Scale 0–1), while 5 (29.4%) remained mildly disabled. One patient experienced sustained worsening. Exploratory analyses showed no significant predictors of favorable outcome, reflecting the limitations of the small cohort. Long-term follow-up (≥ 12 months) was available in only six patients (35.3%).

CONCLUSIONS

Microsurgical resection of selected brainstem cavernous malformations is feasible with acceptable morbidity in experienced hands. However, given the small cohort size, retrospective design, and limited follow-up, these findings should be interpreted cautiously. Larger, multicenter studies are needed to validate prognostic factors and refine surgical indications.