뇌간 해면 기형의 수술적 전략과 신경학적 결과

Surgical Strategy of Brainstem Cavernous Malformation and Neurologic Outcome

Background : Brainstem cavernous malformation (BSCM) is a rare pathology that causes repeated bleeding in the brainstem. The anatomical complexity of the brainstem and high surgical morbidity and mortality rates make surgery difficult. Several authors have shared their experience of surgical removal of BSCM. Methods : Patients diagnosed with BSCM in single institution from 2006 to 2017 were investigated retrospectively. A modified Rankin scale (mRS) was used to assess patients’ neurological status. During surgery, neuronavigation and neuromonitoring were used. Results : The total number of 16 patients were reviewed. The telovelar approach was used most frequently (7 times). mRS on admission versus mRS at last follow up (p = 0.008) and mRS at immediate postoperative versus mRS at last follow-up showed significant difference (p = 0.001). Postoperative neurological deteriorations were noticed in 8 of 16 patients. Neurological outcomes were improved after more than 6 months later during follow up periods. Conclusions : In this study, neurological status may be deteriorated in immediate postoperative but neurological status will be better when followed up for more than 6 months. Surgical techniques and equipment such as high-resolution magnetic resonance imaging, diffusion tensor imaging, 3-dimensional modeling, neuronavigation, and neuromonitoring help surgery of BSCM. So BSCM should be surgically treated in active stance.