Surgical Treatment of Supratentorial Cortico‑ subcortical Cavernous Malformation

Česká verzia

Authors: M. Májovský; D. Netuka; O. Bradáč; V. Beneš
Authors place of work: Neurochirurgická klinika 1. LF UK a ÚVN – VFN Praha
Published in the journal: Cesk Slov Neurol N 2014; 77/110(5): 631-637
Category: Krátké sdělení

Summary

Aim:
The aim of the study is to present surgical outcome of treatment of supratentorial cavernous malformation of the brain at the Department of Neurosurgery, Charles University and the Central Military Hospital in Prague.

Material and methods:
We retrospectively enrolled patients diagnosed between 2000 and 2012 with supratentorial, cortico‑ subcortically located cavernoma. We analysed epidemiological and radiological data, clinical presentation and surgical results including complications.

Results:
Initial symptoms included epileptic seizure (49%), headache (22%) and focal neurological deficit (19%); 15% of cavernomas were found incidentally. Radiological signs of recent haemorrhage on MR scans were found in 27% patients. We performed surgery in 145 patients with 158 cavernous malformations. Twenty five lesions were treated conservatively. Surgical complications occurred in 8% of patients. One patient died and one had permanent neurological deficit attributable to surgery. Postoperative seizure rate was significantly higher in a group with wound infection or postoperative hematoma (p < 0.05).

Conclusion:
Microsurgical resection of lobar cavernoma is relatively safe procedure with minimal morbidity and mortality. Postoperative hematoma or wound infection might have an epileptogenic potential.

Key words:
cavernous malformation – microsurgery – epilepsy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Rokytansky C, Swaine WE. Manual of pathological anatomy. Philadelphia: Blanchard & Lea 1855: 191– 194.

2. Luschka H. Cavernose Blutgeschwulst des Gehirns. Virchows Arch 1854; 6: 458– 470.

3. Dandy WE. Venous abnormalities and angiomas of the brain. Arch Surg 1928; 17: 715– 793.

4. Zvěřina E. Chirurgie cévních onemocnění mozku. In: Kalvach et al (eds). Mozkové ischemie a hemoragie. Praha: Grada Publishing 1997: 321– 351.

5. Kozler P, Beneš V. Supratentoriální kavernomy. Cesk Slov Neurol N 1999; 62/ 95: 271– 276.

6. Moriarity JL, Clatterbuck RE, Rigamonti D. The natural history of cavernous malformations. Neurosurg Clin N Am 1999; 10(3): 411– 417.

7. Rigamonti D, Hadley MN, Drayer BP, Johnson MC, Hoenig‑ Rigamonti K, Knight JT et al. Cerebral cavernous malformations. Incidence and familial occurrence. N Engl J Med 1988; 319(6): 343– 347.

8. Labauge P, Laberge S, Brunereau L, Levy C, Tournier‑ Lasserve E. Hereditary cerebral cavernous angiomas: clinical and genetic features in 57 French families. Lancet 1998; 352(9144): 1892– 1897.

9. Töpper R, Jürgens E, Reul J, Thron A. Clinical significance of intracranial developmental venous anomalies. J Neurol Neurosurg Psychiatry 1999; 67(2): 234– 238.

10. Abdulrauf SI, Kaynar MY, Awad IA. A comparison of the clinical profile of cavernous malformations with and without associated venous malformations. Neurosurgery 1999; 44(1): 41– 46.

11. Dey M, Turner MS, Wollmann R, Awad IA. Fatal „hypertensive“ intracerebral hemorrhage associated with a cerebral cavernous angioma: case report. Acta Neurochir 2011; 153(2): 421– 423. doi: 10.1007/ s00701‑ 010‑ 0801‑ 8.

12. Al‑ Holou WN, O‘Lynnger TM, Pandey AS, Gemmete JJ, Thompson BG, Muraszko KM et al. Natural history and imaging prevalence of cavernous malformations in children and young adults. J Neurosurg Pediatr 2012; 9(2): 198– 205. doi: 10.3171/ 2011.11.PEDS11390.

13. Kondziolka D, Lunsford LD, Kestle JR. The natural history of cerebral cavernous malformations. J Neurosurg 1995; 83(5): 820– 824.

14. Kondziolka D, Monaco EA 3rd, Lunsford LD. Cavernous malformations and hemorrhage risk. Prog Neurol Surg 2013; 27: 141– 146. doi: 10.1159/ 000341774.

15. Kivelev J, Niemelä M, Kivisaari R, Dashti R, Laakso A,Hernesniemi J. Long‑term outcome of patients with multiple cerebral cavernous malformations. Neurosurgery 2009; 65(3): 450– 455. doi: 10.1227/ 01.NEU.0000346269.59554.DB.

16. Bradac O, Majovsky M, de Lacy P, Benes V. Surgery of brainstem cavernous malformations. Acta Neurochir 2013; 155(11): 2079– 2083. doi: 10.1007/ s00701‑ 013‑ 1842‑ 6.

17. Wostrack M, Shiban E, Harmening K, Obermueller T, Ringel F, Ryang YM et al. Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions. Acta Neurochir 2012; 154(8): 1419– 1430. doi: 10.1007/ s00701‑ 012‑ 1411‑ 4.

18. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1(7905): 480– 484.

19. Ostrý S, Belšan T, Otáhal J, Beneš V, Netuka D. Is intraoperative diffusion tensor imaging at 3.0T comparable to subcortical corticospinal tract mapping? Neurosurgery 2013; 73(5): 797– 807. doi: 10.1227/ NEU.0000000000000087.

20. Kivelev J, Niemelä M, Blomstedt G, Roivainen R, Lehecka M, Hernesniemi J. Microsurgical treatment of temporal lobe cavernomas. Acta Neurochir 2011; 153(2): 261– 270. doi: 10.1007/ s00701‑ 010‑ 0812‑ 5.

21. Stavrou I, Baumgartner C, Frischer JM, Trattnig S,Knosp E. Long‑term seizure control after resection of supratentorial cavernomas: a retrospective single‑center study in 53 patients. Neurosurgery 2008; 63(5): 888– 896. doi: 10.1227/ 01.NEU.0000327881.72964.6E.

22. Baumann CR, Acciarri N, Bertalanffy H, Devinsky O, Elger CE, Lo Russo G et al. Seizure outcome after resection of supratentorial cavernous malformations: a study of 168 patients. Epilepsia 2007; 48(3): 559– 563.

23. Amin‑Hanjani S, Ogilvy CS, Ojemann RG, Crowell RM. Risks of surgical management for cavernous malformations of the nervous system. Neurosurgery 1998; 42(6): 1220– 1227.

24. Ferroli P, Casazza M, Marras C, Mendola C, Franzini A, Broggi G. Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy. Neurol Sci 2006; 26(6): 390– 394.

25. D‘Angelo VA, De Bonis C, Amoroso R, Cali A, D‘Agruma L, Guarnieri V et al. Supratentorial cerebral cavernous malformations: clinical, surgical and genetic involvement. Neurosurg Focus 2006; 21(1): e9.

26. Gross BA, Smith ER, Goumnerova L, Proctor MR, Madsen JR, Scott RM. Resection of supratentorial lobar cavernous malformations in children: clinical article. J Neurosurg Pediatr 2013; 12(4): 367– 373. doi: 10.3171/ 2013.7.PEDS13126.

27. Zhou H, Miller D, Schulte DM, Benes L, Rosenow F,Bertalanffy H et al. Transsulcal approach supported by navigation‑ guided Neurophysiological monitoring for resection of paracentral cavernomas. Clin Neurol Neurosurg 2009; 111(1): 69– 78.

28. Jabre A, Patel A. Transsulcal microsurgical approach for subcortical small brain lesions: technical note. Surg Neurol 2006; 65(3): 312– 313.

29. Goel A. Transfalcine approach to a contralateral hemispheric tumour. Acta Neurochir 1995; 135(3– 4): 210– 212.

30. Chi JH, Lawton MT. Posterior interhemispheric approach: surgical technique, application to vascular lesions, and benefits of gravity retraction. Neurosurgery 2006; 59 (Suppl 1): ONS41– ONS49.

31. Niizuma K, Fujimura M, Kumabe T, Higano S, Tominaga T. Surgical treatment of paraventricular cavernous angioma: fibre tracking for visualizing the corticospinal tract and determining surgical approach. J Clin Neurosci 2006; 13(10): 1028– 1032.

32. Manaka S, Ishijima B, Mayanagi Y. Postoperative seizures: epidemiology, pathology and prophylaxis. Neurol Med Chir 2003; 43(12): 589– 600.

33. Lieu AS, Howng SL. Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 2000; 38(1): 45– 52.

34. Raychaudhuri R, Batjer HH, Awad IA. Intracranial cavernous angioma: a practical review of clinical and biological aspects. Surg Neurol 2005; 63(4): 319– 328.

35. Rigamonti D, Spetzler RF, Medina M, Rigamonti K,Geckle DS, Pappas C. Cerebral venous malformations. J Neurosurg 1990; 73(4): 560– 564.

36. Sasaki O, Tanaka R, Koike T, Koide A, Koizumi T, Ogawa H. Excision of cavernous angioma with preservation of coexisting venous angioma. Case report. J Neurosurg 1991; 75(3): 461– 464.

37. Buhl R, Hempelmann RG, Stark AM, Mehdorn HM.Therapeutical considerations in patients with intracranial venous angiomas. Eur J Neurol 2002; 9(2): 165– 169.

38. Yamada S, Liwnicz BH, Thompson JR, Colohan AR, Iacono RP, Tran JT. Pericapillary arteriovenous malformations angiographically manifested as cerebral venous malformations. Neurol Res 2001; 23(5): 513– 521.

39. Wurm G, Schnizer M, Fellner FA. Cerebral cavernous malformations associated with venous anomalies: surgical considerations. Neurosurgery 2005; 57 (Suppl 1): 42– 58.

40. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK et al, American Society of Health‑ System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013, 70(3): 195– 283.

41. Buang SS, Haspani MS. Risk factors for neurosurgical site infections after a neurosurgical procedure: a prospective observational study at Hospital Kuala Lumpur. Med J Malaysia 2012; 67(4): 393– 398.

42. Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2006; 59(1): 126– 133.

43. McClelland S 3rd, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 2007; 45(1): 55– 59.

44. Zhan R, Zhu Y, Shen Y, Shen J, Tong Y, Yu H et al. Post‑operative central nervous system infections after cranial surgery in China: incidence, causative agents and risk factors in 1470 patients. Eur J Clin Microbiol Infect Dis 2014; 33(5): 861– 866. doi: 10.1007/ s10096‑ 013‑ 2026‑ 2.

45. Haines SJ. Efficacy of antibiotics prophylaxis in clean neurosurgical operations. Neurosurgery 1989; 24(3): 401– 405.