Radiosurgery for Cavernous Malformations in Basal Ganglia, Thalamus and Brainstem

2008 ◽  
pp. 31-37 ◽  
Author(s):  
Yoshihisa Kida
Keyword(s):  
Basal Ganglia ◽  
Cavernous Malformations

scholarly journals Cavernous Malformation of Brainstem, Thalamus, and Basal Ganglia

Neurosurgery ◽  
2012 ◽  
Vol 72 (4) ◽  
pp. 573-589 ◽  
Author(s):  
Paritosh Pandey ◽  
Erick M. Westbroek ◽  
Peter A. Gooderham ◽  
Gary K. Steinberg
Keyword(s):  
Basal Ganglia ◽  
Neurological Deficits ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Brain Malformations ◽  
Hemorrhage Risk ◽  
Clinical Records

Abstract BACKGROUND: Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. OBJECTIVE: To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD). METHODS: Clinical records, radiological findings, operative details, and complications of 176 patients with deep CMs were reviewed retrospectively. RESULTS: Of 176 patients with 179 CMs, 136 CMs were in the brainstem, 27 in the basal ganglia, and 16 in the thalamus. Cranial nerve deficits (51.1%), hemiparesis (40.9%), numbness (34.7%), and cerebellar symptoms (38.6%) presented most commonly. Hemorrhage presented in 172 patients (70 single, 102 multiple). The annual retrospective hemorrhage rate was 5.1% (assuming CMs are congenital with uniform hemorrhage risk throughout life); the rebleed rate was 31.5%/patient per year. Surgical approach depended on the proximity of the CM to the pial or ependymal surface. Postoperatively, 121 patients (68.8%) had no new neurological deficits. Follow-up occurred in 170 patients. Delayed postoperative HOD developed in 9/134 (6.7%) patients with brainstem CMs. HOD occurred predominantly following surgery for pontine CMs (9/10 patients). Three patients with HOD had palatal myoclonus, nystagmus, and oscillopsia, whereas 1 patient each had limb tremor and hemiballismus. At follow-up, 105 patients (61.8%) improved, 44 (25.9%) were unchanged, and 19 (11.2%) worsened neurologically. Good preoperative modified Rankin Score (98.2% vs 54.5%, P = .001) and single hemorrhage (89% vs 77.3%, P < .05) were predictive of good long-term outcome. CONCLUSION: Symptomatic deep CMs can be resected with acceptable morbidity and outcomes. Good preoperative modified Rankin Score and single hemorrhage are predictors of good long-term outcome.

scholarly journals Transsylvian-Transinsular Approaches to the Insula and Basal Ganglia

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 824-834 ◽  
Author(s):  
◽  
Matthew B. Potts ◽  
Edward F. Chang ◽  
William L. Young ◽  
Michael T. Lawton
Keyword(s):  
Basal Ganglia ◽  
Posterior Approach ◽  
Sylvian Fissure ◽  
Vascular Pathology ◽  
Vascular Lesions ◽  
Dominant Hemisphere ◽  
Cavernous Malformations ◽  
Temporal Lobes ◽  
Scale Scores ◽  
Transinsular Approach

Abstract BACKGROUND: Lesions in the insula and basal ganglia can be risky to resect because of their depth and proximity to critical structures, particularly in the dominant hemisphere. Transsylvian approaches shorten the surgical distance to these lesions, preserve perisylvian temporal and frontal cortex, and minimize brain transgression. OBJECTIVE: To report our experience with transsylvian-transinsular approaches to vascular lesions. METHODS: The anterior approach opened the sphenoidal and insular portions of the sylvian fissure and exposed the limen insulae and short gyri, whereas the posterior approach opened the insular and opercular portions of the sylvian fissure and exposed the circular sulcus and long gyri. RESULTS: Forty-one patients with vascular lesions (24 arteriovenous malformations [AVMs] and 17 cavernous malformations) were treated surgically with a transsylvian-transinsular approach. Complete resection was obtained in 87.5% of AVMs and 95% of cavernous malformations. Permanent neurological morbidity related to surgery was observed in 2 AVM patients (5%), with the remaining 39 patients (95%) improved or unchanged postoperatively (modified Rankin Scale scores 0-2 in 83%). There were no new language deficits in patients with dominant hemisphere lesions. CONCLUSION: Transsylvian-transinsular approaches safely expose vascular pathology in or deep to the insula while preserving overlying eloquent cortex in the frontal and temporal lobes. The anterior transsylvian-transinsular approach can be differentiated from the posterior approach based on technical differences in splitting the sylvian fissure and anatomic differences in final exposure. Discriminating patient selection and careful microsurgical technique are essential.

CAVERNOUS MALFORMATIONS OF THE BASAL GANGLIA AND THALAMUS

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 7-19 ◽  
Author(s):  
Bradley A. Gross ◽  
H. Hunt Batjer ◽  
Issam A. Awad ◽  
Bernard R. Bendok
Keyword(s):  
Basal Ganglia ◽  
Natural History ◽  
French Literature ◽  
Outcome Data ◽  
Therapeutic Modality ◽  
Surgical Morbidity ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome

ABSTRACT CAVERNOUS MALFORMATIONS OF the basal ganglia and thalamus present a unique therapeutic challenge to the neurosurgeon given their unclear natural history, the risk of surgical treatment, and the unproven efficacy of radiosurgical therapy. Via a PubMed search of the English and French literature, we have systematically reviewed the natural history and surgical and radiosurgical management of these lesions reported through April 2008. Including rates cited for “deep” cavernous malformations, annual bleeding rates for these lesions varied from 2.8% to 4.1% in the natural history studies. Across surgical series providing postoperative or long-term outcome data on 103 patients, we found an 89% resection rate, a 10% risk of long-term surgical morbidity, and a 1.9% risk of surgical mortality. The decrease in hemorrhage risk reported 2 years after radiosurgery might be a result of natural hemorrhage clustering, underscoring the unproven efficacy of this therapeutic modality. Given the compounded risks of radiation-induced injury and post-radiosurgical rebleeding, radiosurgery at modest dosimetry (12–14 Gy marginal doses) is only an option for patients with surgically inaccessible, aggressive lesions.

The Supracarotid-infrafrontal Approach: Surgical Technique and Clinical Application to Cavernous Malformations in the Anteroinferior Basal Ganglia

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS86-ONS95 ◽  
Author(s):  
James S. Waldron ◽  
Michael T. Lawton
Keyword(s):  
Basal Ganglia ◽  
Posterior Part ◽  
Internal Capsule ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Working Space ◽  
Brain Surface ◽  
Careful Handling ◽  
Surgical Corridor ◽  
Perforating Arteries

Abstract Objective: Many symptomatic cavernous malformations deep in the anteroinferior basal ganglia are deemed to be inoperable and managed conservatively because transcortical, transsylvian-transinsular, and transcallosal approaches are unsuitable. We present an approach to these lesions through the supracarotid triangle, between ascending perforators, and through the basomedial frontal lobe. Methods: The supracarotid-infrafrontal approach incorporates an orbitozygomatic craniotomy, wide microsurgical exposure of the supracarotid triangle, dissection of perforating arteries, and image-guided resection through the posterior part of the medial orbital gyrus and anterior perforated substance. Results: During 10 years of surgical experience with 269 patients with cavernous malformations, 5 patients were identified with lesions in the basal ganglia that were resected completely using the supracarotid-infrafrontal approach. Transient neurological deficits were observed postoperatively in 2 patients, and all patients had excellent outcomes (modified Rankin Scale score of 0 or 1; mean duration of follow-up, 1.4 years). Conclusion: Cavernous malformations in the anteroinferior basal ganglia come to the brain surface directly behind the internal carotid artery bifurcation, and the supracarotid-infrafrontal trajectory best matches the lesions' axes. The surgical corridor runs between perforating arteries, but entrance into these lesions opens additional working space that is not normally present when the approach is used with aneurysms. Careful handling of crossing and ascending perforating arteries is critical, as is delicate dissection of the lesion's superior pole where it abuts the internal capsule.

Analysis of the utility of early MRI/MRA in 400 patients with spontaneous intracerebral hemorrhage

2020 ◽  
Vol 132 (6) ◽  
pp. 1865-1871 ◽  
Author(s):  
Nohra Chalouhi ◽  
Nikolaos Mouchtouris ◽  
Fadi Al Saiegh ◽  
Somnath Das ◽  
Ahmad Sweid ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Yield ◽  
Sinus Thrombosis ◽  
Patient Age ◽  
Cavernous Malformations ◽  
Arteriovenous Fistulas ◽  
Patient Âgé ◽  
Structural Abnormalities ◽  
Additional Imaging

OBJECTIVEMRI and MRA studies are routinely obtained to identify the etiology of intracerebral hemorrhage (ICH). The diagnostic yield of MRI/MRA in the setting of an acute ICH, however, remains unclear. The authors’ goal was to determine the utility of early MRI/MRA in detecting underlying structural lesions in ICH and to identify patients in whom additional imaging during hospitalization could safely be foregone.METHODSThe authors reviewed data obtained in 400 patients with spontaneous ICH diagnosed on noncontrast head CT scans who underwent MRI/MRA between 2015 and 2017 at their institution. MRI/MRA studies were reviewed to identify underlying lesions, such as arteriovenous malformations, aneurysms, cavernous malformations, arteriovenous fistulas, tumors, sinus thrombosis, moyamoya disease, and abscesses.RESULTSThe median patient age was 65 ± 15.8 years. Hypertension was the most common (72%) comorbidity. Structural abnormalities were detected on MRI/MRA in 12.5% of patients. Structural lesions were seen in 5.7% of patients with basal ganglia/thalamic ICH, 14.1% of those with lobar ICH, 20.4% of those with cerebellar ICH, and 27.8% of those with brainstem ICH. Notably, the diagnostic yield of MRI/MRA was 0% in patients > 65 years with a basal ganglia/thalamic hemorrhage and 0% in those > 85 years with any ICH location, whereas it was 37% in patients < 50 years and 23% in those < 65 years. Multivariate analysis showed that decreasing age, absence of hypertension, and non–basal ganglia/thalamic location were predictors of finding an underlying lesion.CONCLUSIONSThe yield of MRI/MRA in ICH is highly variable, depending on patient age and hemorrhage location. The findings of this study do not support obtaining early MRI/MRA studies in patients ≥ 65 years with basal ganglia/thalamic ICH or in any ICH patients ≥ 85 years. In all other situations, early MRI/MRA remains valuable in ruling out underlying lesions.

Transsylvian, Transanterior Sulcus Approach to Basal Ganglia Cavernous Malformations

2017 ◽  
Vol 13 (6) ◽  
pp. 756-756
Author(s):  
M Yashar S Kalani ◽  
Kaan Yağmurlu ◽  
Nikolay L Martirosyan ◽  
Robert F Spetzler
Keyword(s):  
Basal Ganglia ◽  
Cavernous Malformations

scholarly journals Basal ganglia cavernous malformations: case series and systematic review of surgical management and long-term outcomes

2021 ◽  
pp. 1-9
Author(s):  
Yiping Li ◽  
Anadjeet Khahera ◽  
Jason Kim ◽  
Mauricio Mandel ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Case Series ◽  
Anatomical Location ◽  
Lentiform Nucleus ◽  
Cavernous Malformations ◽  
Posterior Limb ◽  
Lesion Location ◽  
Permanent Morbidity

OBJECTIVEReports on basal ganglia cavernous malformations (BGCMs) are rare. Here, the authors report on their experience in resecting these malformations to offer insight into this infrequent disease subtype.METHODSThe authors retrospectively reviewed a prospectively managed departmental database of all deep-seated cerebral cavernous malformations (CCMs) treated at Stanford between 1987 and 2019 and included for further analysis those with a radiographic diagnosis of BGCM. Moreover, a systematic literature review was undertaken using the PubMed and Web of Science databases.RESULTSThe departmental database search yielded 331 patients with deep-seated CCMs, 44 of whom had a BGCM (13.3%). Headache was the most common presenting sign (53.5%), followed by seizure (32.6%) and hemiparesis (27.9%). Lesion location involved the caudate nucleus in 21.4% of cases compared to 78.6% of cases within the lentiform nucleus. Caudate BGCMs were larger on presentation and were more likely to present to the ependymal surface (p < 0.001) with intraventricular hemorrhage and hydrocephalus (p = 0.005 and 0.007, respectively). Dizziness and diplopia were also more common with lesions involving the caudate. Because of their anatomical location, caudate BGCMs were preferentially treated via an interhemispheric approach and were less likely to be associated with worsening perioperative deficits than lentiform BGCMs (p = 0.006 and 0.045, respectively). Ten patients (25.6%) were clinically worse in the immediate postoperative period, 4 (10.2%) of whom continued to suffer permanent morbidity at the last follow-up. A long-term good outcome (modified Rankin Scale [mRS] score 0–1) was attained in 74.4% of cases compared to the 69.2% of patients who had presented with an mRS score 0–1. Relative to their presenting mRS score, 89.8% of patients had an improved or unchanged status at the last follow-up. The median postoperative follow-up was 11 months (range 1–252 months). Patient outcomes after resection did not differ among surgical approaches; however, patients presenting with hemiparesis and lesions involving the globus pallidus or posterior limb of the internal capsule were more likely to suffer neurological deficits during the immediate perioperative period. Patients who had undergone awake surgeries were more likely to suffer neurological decline at the early as well as the late follow-up. When adjusting for awake craniotomy as a potential confounder of lesion location, a BGCM involving the posterior limb was predictive of developing early postoperative deficits, but this finding did not persist at the long-term follow-up.CONCLUSIONSSurgery is a safe and effective treatment modality for managing BGCMs, with an estimated long-term permanent morbidity rate of around 10%.

scholarly journals SEQUENTIAL HEMORRHAGE IN TWO LESIONS OF MULTIPLE CEREBRAL CAVERNOUS MALFORMATIONS: A CASE REPORT

2017 ◽  
Vol 16 (4) ◽  
pp. 149-153
Author(s):  
Dan-Sorin Buzoianu ◽  
◽  
Maria-Irina Munteanu ◽  
Armand Frasineanu ◽  
Radu-Dan Mihailescu ◽  
...  
Keyword(s):  
Case Report ◽  
Basal Ganglia ◽  
Cerebral Cavernous Malformations ◽  
Conservative Approach ◽  
Cavernous Malformations ◽  
Different Ages ◽  
History Of ◽  
The Right

We present the case of a 64-year old female, with a 5 year history of symptomatic multiple cerebral cavernomas, who developed paresthesia in the right leg and arm, followed by vertigo, slurred speech and forward gaze diplopia. Brain investigation revealed two lesions with supra- and infratentorial localization with signs of recent hemorrhage of different ages. The localization of the lesions in the midpons and the basal ganglia imposed a conservative approach.

Cavernous malformations of the basal ganglia in children

2013 ◽  
Vol 12 (2) ◽  
pp. 171-174 ◽  
Author(s):  
Bradley A. Gross ◽  
Edward R. Smith ◽  
R. Michael Scott
Keyword(s):  
Basal Ganglia ◽  
Mass Effect ◽  
Neurological Impairment ◽  
Senior Author ◽  
Neurological Deterioration ◽  
Neurological Dysfunction ◽  
Lentiform Nucleus ◽  
Cavernous Malformations ◽  
Female Ratio

Object Cavernous malformations (CMs) of the basal ganglia are relatively rare lesions that can lead to considerable neurological impairment because of their eloquent location. The authors reviewed the clinical course and surgical outcome of a series of children with basal ganglia CMs. Methods The authors retrospectively reviewed the operative experience of the senior author (R.M.S.) and the 1997–2011 database of Boston Children's Hospital for children with CM of the basal ganglia (which includes CM of the caudate and/or lentiform nucleus and excludes CM of the thalamus). They evaluated baseline demographics, presenting signs, operative outcomes, and condition at long-term follow-up visits and compared these characteristics among patients who underwent surgery and those who were observed. Results Of 180 children with a diagnosis of CM, 11 (6%) had CM of the basal ganglia. The mean age at diagnosis was 9.3 years, and the male/female ratio was 1.8:1. Presenting signs were as follows: hemorrhage (8 children), incidental lesions (2), and seizures (1); 2 children had choreiform movement disorders. Treatment was observation or surgery. Observation was chosen for 5 children either because the lesions were asymptomatic (2 children) or because the risk for neurological dysfunction after attempted excision was believed to be high (3 children). These 5 children were observed over a combined total of 30.4 patient-years; none experienced neurological deterioration or symptomatic hemorrhage from their lesions. The other 6 children underwent microsurgical resection of the lesion because they were symptomatic from hemorrhage or increasing mass effect. All 6 of these children had hemorrhagic lesions, of which the smallest dimension was at least 1.5 cm. Of these 6 lesions, 5 were excised completely, and over a combined total of 46 patient-years of follow-up, no rebleeding or late neurological deterioration after surgery was reported. Conclusions In this patient population, the natural history of small and asymptomatic CMs of the basal ganglia was benign. The children with large (> 1.5 cm) symptomatic lesions underwent excision; neurological impairment was apparently minimal, and no hemorrhage or neurological deterioration occurred later.

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