Breaking through the "forbidden area", a review of the treatment of brainstem cavernous hemangioma in the past 10 years

The main hazard of cerebral cavernous hemangioma is repeated bleeding, but this bleeding is often small, slow bleedin.

Surgery is the first choice for the treatment of brainstem cavernous hemangioma, and total resection can often achieve cur.

Brain cavernous hemangioma is not a tumor!

Strictly speaking, cavernous hemangioma is not a tumor, it refers to a cavernous abnormal vascular mass composed of many thin-walled blood vessels, which occurs both on the body surface and in the bod.

Dangerous brainstem cavernous hemangioma

When this benign lesion is located in the brainstem, it is like a ticking time bom.

The first bleeding is a wake-up call for the patien.

How is a brainstem cavernous hemangioma treated?

Total surgical resection of the lesion is the most effective means to prevent re-bleeding, and it is also the fundamental method for patients to obtain curative effect.

The requirements for the chief surgeon are extremely harsh, because if a little carelessness occurs, the patient may not be able to get off the operating table, or be unconscious in the ICU, so doctors are often recommended conservative treatmen.

Is brainstem cavernous hemangioma a terminal illness? NO!

INC International Brainstem Surgery Specialists evaluate the best timing for surgery as follows:

Simply put, brain stem cavernous hemangioma is like a pest that grows in the center of a tree trun.

Dashu has to take huge risks and reluctantly undergo surger.

Can brain stem cavernous hemangioma be operated on?

What does a review of treatment research in the past 10 years say?

On February 26, 2020, "Neurochirurgie" magazine published online the paper "Brainstem cavernous malformations - no longer a forbidden territory? A systemic review of recent literature" written by Yuen .

Screenshot of the abstract of the paper

2010-2018 Review of the treatment of brainstem cavernous hemangioma

mRS: modified Rankin score; GoS: Glasgow Outcome Score; NIHSS: National Institutes of Health Stroke Scale; HOD: Olivary hypertrophic degeneration; AHR: Annual bleeding rat.

The study evaluated 222 search studies, and after deduplication, only clinical articles with ≥30 cases of brainstem cavernous malformation (CCM) were included, and 28 articles were finally included in the stud.

 in conclusion 

Brainstem cavernous hemangioma accounts for about 20% of all intracranial cavernous hemangiomas in the central nervous system, mainly occurring in the pon.

Due to the complex and important anatomy of the brainstem and the important surrounding nerve and vascular structures, microscopic resection of brainstem cavernous hemangiomas may risk damaging important functional structure.

This question requires a decision-making process when considering whether or not to operat.

The indications and efficacy of stereotactic radiosurgery (SRS) in cavernous malformations are still controversia.

 INC International Skull Base Brainstem Surgery Master

Professor Bart Langfield's point of view 

Surgical intervention is the first choice for treatment

Cavernous hemangioma is very common in clinic, and there are many symptom.
The main symptoms are epilepsy, chronic bleeding, and neurological dysfunctio.
The location of the brainstem is deep and the treatment is difficult to some extent, but from our experience, the intervention of microneurosurgery is still the first choice, because in most cases, the lesions can be safely removed without leaving residues or generating more nerve.
Dysfunctio.
Brainstem cavernous hemangioma also has its own specificity, and the bleeding rate is more likely to cause dysfunctio.
The more profound it is, the more it should be surger.

Indications for surgery

The literature summarizes some inconclusive data, including the frequency of bleeding and the risk of rebleedin.
In the literature, the bleeding rate is 2%-5%/person/year, and the rebleeding rate is 7%-60%/person/yea.
A recent study showed that the preoperative bleeding rate was 6%/person/year, and the rebleeding rate was 35%/person/yea.
Although the rate of rebleeding is imprecise, it is certain that the rate of rebleeding increases after the first blee.

Member of the INC World Neurosurgery Advisory Group, Chairman of the WFNS Education Committee of the World Federation of Neurosurgery, Professor Helmut Bertalanffy (Bart Langffy), a professor of neurology at the INI International Neurological Institute in Germany, comprehensively 231 cases of surgical experienc.
The main points of treatment are summarized as follows:

Severe clinical symptoms suggest surgical indications;

Incidentally discovered (static, no clinical manifestations, no bleeding) cavernous hemangioma temporarily does not require surgical treatment;

In patients with rapid progression, urgent surgical resection of the tumor is beneficial;

There are many surgical approaches to choose from, but the shortest surgical approach to the tumor is not necessarily the best surgical approach;

More than 90% of patients have a good recovery;

Patients with recurrent bleeding should be re-operate.

Based on the clinical case data of brainstem cavernous hemangioma, published papers, and monographs, Professor Bart Langfield summarized the surgical treatment effects, mainly including the imaging characteristics, operation timing and operation timing of 231 cases of mesencephalic, pontine, and medullary cavernous hemangioma.
Approach selection and overall clinical effect, of which 208 cases (90%) recovered well after surgery (see above picture)

Surgical approach

The brainstem includes the midbrain, brainstem, and medulla oblongat.
Professor INC Ba conducts research on the classification and surgical approach of brainstem cavernous hemangioma, and can use different surgical procedures skillfully and experienced according to the location and shape of brainstem tumor.
Ways to achieve the safest and most effective surgical resection:

Surgical approaches for brainstem-midbrain cavernous hemangioma, including anterior interhemispheric approach, orbitozygomatic transsylvian approach, infratemporal approach, supracerebellar approach, and occipital transtentorial approach, et.

The surgical approach for brainstem medullary cavernous hemangioma can choose transmedulla approach and far lateral approach

The surgical approach for brainstem pontine cavernous hemangioma includes transmedulla approach, transpontine arm approach, far lateral approach, superior lateral cerebellar approach, and inferior temporal transtentorial approach

References:

DOI: https://do.
org/118791/nsatla.
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doi:11016/.
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