Introduction: Surgery of intra-axial brain stem lesions belong to the most challenging neurosurgical procedures especially when performed in the absence of some modern neurosurgical tools.
Methods: We reviewed the surgical outcome of 72 cases surgically treated for intrinsic brain stem space occupying lesions at the Neurosurgery Department, Alexandria University, Egypt, between 2008 and 2014. All These cases were operated upon while lacking any sort of intraoperative image guidance, while intraoperative neurophysiological monitoring was deficient in 18 cases.
Results: These cases were divided into 2 groups; the first group comprises 48 cases of brain stem glioma with a mean age of 21 years, and the second group comprises 24 cases operated for brain stem cavernoma where the mean age was 34 years.
The first group underwent 59 surgical procedures; 5 of which were CSF diversion procedures. There were 2 post-operative mortalities; pneumonia and pulmonary embolism. The most common post-operative complication was cranial nerves deficits; however it was permanent in only 4 cases (8.3%). Total resection rate was 29% and the most common pathology was pilocytic astrocytoma.
There was a single post operative mortality in the second group. Fourteen cases (58.3%) showed initial worsening of their preoperative neurological status, most of which were transient and only 3 patients had permanent new deficits and one case had a permanent worsening of her preoperatively existing hemiparesis. There was neither immediate nor long-term rebleeding in any of our cases.
Conclusions: Satisfactory surgical outcome is possible for selected intrinsic brain stem lesions even with the limited resources of a developing country.
Patient Care: it confronts the established concept of inoperability of all brain stem lesions prevailing in many developing countries.
it describes how to overcome the limited resources in a developing country to achieve favorable outcomes
Learning Objectives: define the surgical indications in brain stem glioma and cavernoma.
underline the possible complcations
call attention to the role of intraoperative monitoring and image guidance in this type of surgery