Dale Ding1, Robert M Starke2, R Webster Crowley3, Kenneth C Liu1,4. 1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. 2. Department of Neurological Surgery, University of Miami, Miami, FL, USA. 3. Department of Neurological Surgery, Rush University, Chicago, IL, USA. 4. Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
Abstract
OBJECTIVE: Surgical resection of thalamic and brainstem cerebral cavernous malformations (CCMs) is associated with significant operative morbidity, but it may be outweighed, in some cases, by the neurological damage from recurrent hemorrhage in these eloquent areas. The goals of this retrospective cohort study are to describe the technical nuances of surgical approaches and determine the postoperative outcomes for CCMs of the thalamus and brainstem. MATERIALS AND METHODS: We reviewed an institutional database of patients harboring thalamic or brainstem CCMs, who underwent surgical resection from 2010 to 2014. The baseline and follow-up neuroimaging and clinical findings of each patient and the operative details of each case were evaluated. RESULTS: A total of eight patients, including two with thalamic and six with brainstem CCMs, were included in the study cohort. All patients had progressive neurological deterioration from recurrent CCM hemorrhage, and the median modified Rankin Scale (mRS) at presentation was 3. The median CCM maximum diameter and volume were 1.7 cm and 1.8 cm3, respectively. The thalamic CCMs were resected using the anterior transcallosal transchoroidal and supracerebellar infratentorial approaches each in one case (13%). The brainstem CCMs were resected using the retrosigmoid and suboccipital trans-cerebellomedullary fissure approaches each in three cases (38%). After a median follow-up of 11.5 months, all patients were neurologically stable or improved, with a median mRS of 2. The rate of functional independence (mRS 0-2) was 63%. CONCLUSION: Microneurosurgical techniques and approaches can be safely and effectively employed for the management of thalamic and brainstem CCMs in appropriately selected patients.
OBJECTIVE: Surgical resection of thalamic and brainstem cerebral cavernous malformations (CCMs) is associated with significant operative morbidity, but it may be outweighed, in some cases, by the neurological damage from recurrent hemorrhage in these eloquent areas. The goals of this retrospective cohort study are to describe the technical nuances of surgical approaches and determine the postoperative outcomes for CCMs of the thalamus and brainstem. MATERIALS AND METHODS: We reviewed an institutional database of patients harboring thalamic or brainstem CCMs, who underwent surgical resection from 2010 to 2014. The baseline and follow-up neuroimaging and clinical findings of each patient and the operative details of each case were evaluated. RESULTS: A total of eight patients, including two with thalamic and six with brainstem CCMs, were included in the study cohort. All patients had progressive neurological deterioration from recurrent CCM hemorrhage, and the median modified Rankin Scale (mRS) at presentation was 3. The median CCM maximum diameter and volume were 1.7 cm and 1.8 cm3, respectively. The thalamic CCMs were resected using the anterior transcallosal transchoroidal and supracerebellar infratentorial approaches each in one case (13%). The brainstem CCMs were resected using the retrosigmoid and suboccipital trans-cerebellomedullary fissure approaches each in three cases (38%). After a median follow-up of 11.5 months, all patients were neurologically stable or improved, with a median mRS of 2. The rate of functional independence (mRS 0-2) was 63%. CONCLUSION: Microneurosurgical techniques and approaches can be safely and effectively employed for the management of thalamic and brainstem CCMs in appropriately selected patients.
Authors: Jean G de Oliveira; Gregory P Lekovic; Sam Safavi-Abbasi; Cassius V Reis; Ricardo A Hanel; Randall W Porter; Mark C Preul; Robert F Spetzler Journal: Neurosurgery Date: 2010-02 Impact factor: 4.654
Authors: Robert M Starke; Jason P Sheehan; Dale Ding; Kenneth C Liu; Douglas Kondziolka; Richard W Crowley; L Dade Lunsford; Neal F Kassell Journal: World Neurosurg Date: 2014-07-15 Impact factor: 2.104
Authors: Dale Ding; Robert M Starke; Hideyuki Kano; David Mathieu; Paul P Huang; Douglas Kondziolka; Caleb Feliciano; Rafael Rodriguez-Mercado; Luis Almodovar; Inga S Grills; Danilo Silva; Mahmoud Abbassy; Symeon Missios; Gene H Barnett; L Dade Lunsford; Jason P Sheehan Journal: World Neurosurg Date: 2017-03-23 Impact factor: 2.104
Authors: Dale Ding; Robert M Starke; Hideyuki Kano; David Mathieu; Paul P Huang; Caleb Feliciano; Rafael Rodriguez-Mercado; Luis Almodovar; Inga S Grills; Danilo Silva; Mahmoud Abbassy; Symeon Missios; Douglas Kondziolka; Gene H Barnett; L Dade Lunsford; Jason P Sheehan Journal: J Neurosurg Pediatr Date: 2016-12-02 Impact factor: 2.375
Authors: Christopher S Hong; Eric C Peterson; Dale Ding; Samir Sur; David Hasan; Aaron S Dumont; Nohra Chalouhi; Pascal Jabbour; Robert M Starke Journal: Clin Neurol Neurosurg Date: 2016-09-15 Impact factor: 1.876
Authors: Jordan R Conger; Dale Ding; Daniel M Raper; Robert M Starke; Christopher R Durst; Kenneth C Liu; Mary E Jensen; Avery J Evans Journal: J Cerebrovasc Endovasc Neurosurg Date: 2016-06-30