[Brain-stem cavernous hemangioma: surgical indications and approaches].

OBJECTIVE

To evaluate the surgical indications and prognosis for cavernous hemangiomas (CHs) in the brain-stem.

METHODS

From 1992 to 2000, 163 patients with intracranial CHs were operated on in our department. Among them, 14 patients (8 women and 6 men; mean age 42 years) had 15 CHs in the pons (12), mesencephalon (1) and medulla oblongata (1). Surgical indications for CHs are: progressive focal neurological deficits; hemorrhage; near the surface of the brainstem. Transvemian approach with midline suboccipital craniotomy was used for the lesions in the pons and medulla, near the floor of the IV cerebral ventricle. Transpetrosal approach was used for the lesions in the anterior part of the pons, and infratentorial supracerebellar approach for those in the mesencephalic case.

RESULTS

CHs were totally removed from all the 15 lesions. Neurological deficits were improved in 10 patients after operation. Two patients had transient worsening of neurological conditions, which returned to the preoperative status during follow-up. The mesencephalic case, however had neurological condition deteriorated and was homebound after surgery. Pathologically, an oligodendroglioma was seen with CH in this case.

CONCLUSIONS

If surgically indicated, CHs involving the brain-stem can be resected. Minimal invasiveness techniques and careful operative planning may contribute to the treatment of CHs involving the brain-stem.