Risks of Surgical Management for Cavernous Malformations of the Nervous System
Open Access
- 1 June 1998
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 42 (6), 1220-1227
- https://doi.org/10.1097/00006123-199806000-00007
Abstract
As more information evolves regarding the natural history of cavernous malformations (CMs), the risks' of operative intervention must be balanced against nonoperative management. In an attempt to better delineate 1 the surgical risks for operable CMs, we undertook a retrospective analysis of 94 patients with 97 CMs surgically 11 excised at the Massachusetts General Hospital. Data regarding surgical complications and outcome measures, including neurological status and seizure outcome, were analyzed. The incidence of transient neurological morbidity was 20.6%, but only 4 of the 97 operations (4.1%) R resulted in persistent disabling neurological complications and 2 (2.1%) in nondisabling deficits. There was no c operative mortality. Brain stem lesions (n = 14) were associated with the highest incidence of neurological ( complications, both transient and persistent (odds ratio, 4.8; 95% confidence interval, 1.5–15.7). The overall n neurological outcome was excellent or good in 89.7% of all lesions: 96.8% of lobar CMs (n = 63), 64.2% of brain r stem CMs (n = 14), 87.5% of cerebellar CMs (n = 8), 100% of cranial nerve CMs (n = 4), and 75% of spinal J cord CMs (n = 8). Patients with brain stem and spinal cord CMs were in poorer preoperative neurological condition than were patients with CMs in other locations and therefore had a significantly reduced level of - function after surgery (P ' 0.01). There was improvement in 35.7% of the patients with brain stem lesions and 8 62.5% of the patients with spinal cord lesions after surgery. In the 38 patients presenting with seizures, 97% were ? seizure-free after surgery. The risks of operative management of CMs varies based on location. When evaluating patients with operable CMs for surgery, the incidence of complications as well as final neurological outcome should be carefully weighed against the existing knowledge of the natural history of lesions managed expectantly.Keywords
This publication has 33 references indexed in Scilit:
- Seizure outcome after lesionectomy for cavernous malformationsJournal of Neurosurgery, 1995
- Natural history of intracranial cavernous malformationsJournal of Neurosurgery, 1995
- Cavernous malformations of the brain stemActa Neurochirurgica, 1994
- A Simple Method for Stereotactic Microsurgical Excision of Small, Deep-seated Cavernous AngiomasNeurosurgery, 1994
- Surgical resection of intramedullary spinal cord cavernous malformationsJournal of Neurosurgery, 1993
- Intracranial and orbital cavernous angiomas: A review of 74 surgical casesBritish Journal Of Neurosurgery, 1993
- Indications for Surgery and Prognosis in Patients with Cerebral Cavernous AngiomasNeurologia medico-chirurgica, 1992
- An analysis of the natural history of cavernous angiomasJournal of Neurosurgery, 1991
- Stereotactic resection of occult vascular malformationsJournal of Neurosurgery, 1990
- Cavernous angiomas of the spinal cordJournal of Neurosurgery, 1988