Surgery for Symptomatic Thalamic and Brainstem Cavernous Malformations

Three recent articles in World Neurosurgery (May-June 2013) address cavernoma resection in eloquent brain regions such as thalamus and brainstem. They emphasize complete resection of symptomatic brainstem and thalamic cavernomas with appropriate surgical approach and use of adjunct fiberoptic CO2 laser. Li et al describe a retrospective single cohort review of a large series of 27 symptomatic thalamic cavernomas with previous hemorrhage. Gross total resection was achieved in 26 patients (96.3%). At a mean of 48.7 months follow-up, 92.6% showed symptomatic improvement. Mai et al describe a retrospective single cohort review of 22 patients with symptomatic brainstem cavernomas, with 19 patients presenting with hemorrhage. Gross total resection was achieved in 91% of patients, with 86% having unchanged or improved neurological status at a mean follow-up of 26.6 months. Consiglieri et al describe using a fiberoptic CO2 laser as an adjunct for resecting eloquent brain cavernomas (13 brainstem and 2 thalamus). The CO2 laser was useful in a majority of cases, especially for creating precise, controlled corticectomies and for shrinking and separating lesions from adjacent eloquent brain. The CO2 laser was not effective on calcified areas or for hemostasis.

Andrew W. Grande, MD
Minneapolis, MN

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