Surgical Resection of Intrinsic Brain Stem Lesions: An Overview

Abstract A major limitation to the effective treatment of intrinsic mass lesions of the brain stem has been the inability to clearly define the pathological anatomy radiographically. The improved soft tissue resolution offered by magnetic resonance imaging, as compared with axial computed tomography, now makes it possible not only to accurately distinguish anatomical relationships, but also to predict the pathological nature of the lesion. Accordingly, we have been encouraged to pursue a more aggressive approach to intrinsic lesions of the brain stem that appear well circumscribed on magnetic resonance imaging scan. The object of this paper is to report the successfuly treatment of four intrinsic lesions of the brain stem and to present an overview of the relevant published experience.

Download Full-text

The Clinical Impact of Magnetic Resonance Imaging in the Diagnosis of Brain Stem Lesions

Digitale bildgebende Verfahren Interventionelle Verfahren Integrierte digitale Radiologie ◽

10.1007/978-3-642-73134-1_18 ◽

1988 ◽

pp. 89-94

Author(s):

G. Bone ◽

L. Dinkhauser ◽

W. Artmann ◽

G. Ladurner

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Stem ◽

Clinical Impact ◽

Resonance Imaging ◽

Brain Stem Lesions ◽

Stem Lesions

Download Full-text

The Spectrum of Brain Stem Lesions in Children

Journal of Pediatric Neurology ◽

10.1055/s-0040-1714068 ◽

2020 ◽

Author(s):

Hanuman Prasad Prajapati ◽

Raj Kumar

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Stem ◽

Pediatric Patients ◽

Neurophysiological Monitoring ◽

Resonance Imaging ◽

Improved Outcomes ◽

Brain Stem Lesions ◽

Stem Lesions ◽

Brain Stem Gliomas

AbstractThe objective of this study was to describe the clinicodemographic profiles, management, and outcomes of brain stem lesions in 53 pediatric patients with brain stem lesions. Most of the patients were male, 6 to 10 years of age (8.66 ± 4.69). Out of 53 patients, there were 77.36% brain stem gliomas, 11.32% tuberculomas, 5.66% abscesses, 3.77% cavernomas, and 1.89% schwannomas. With advancement in neuroimaging (e.g., tractography), intraoperative technology (e.g., ultrasound, neurophysiological monitoring, and magnetic resonance imaging), and safe and precise incision for particular lesions, majority of brain stem lesions had improved outcomes (67.92%) with significant reduction in morbidity and mortality (11.32%).

Download Full-text

Differentiation of mechanism and prognosis of traumatic brain stem lesions detected by magnetic resonance imaging in the acute stage

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(00)00095-0 ◽

2000 ◽

Vol 102 (3) ◽

pp. 124-128 ◽

Cited By ~ 28

Author(s):

Yasushi Shibata ◽

Akira Matsumura ◽

Kotoo Meguro ◽

Kiyoshi Narushima

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Stem ◽

Acute Stage ◽

Resonance Imaging ◽

Brain Stem Lesions ◽

Stem Lesions ◽

Traumatic Brain Stem Lesions

Download Full-text

Surgical Removal of Pontomesencephalic Cavernous Hemangiomas

Neurosurgery ◽

10.1227/00006123-199003000-00012 ◽

1990 ◽

Vol 26 (3) ◽

pp. 449-457 ◽

Cited By ~ 88

Author(s):

R. Fahlbusch ◽

C. Strauss ◽

W. Huk ◽

G. Röckelein ◽

D. Kömpf ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Stem ◽

Auditory Evoked Potentials ◽

Neurological Deficits ◽

Surgical Removal ◽

Resonance Imaging ◽

Aggressive Approach ◽

Cavernous Hemangiomas ◽

The Brain

Abstract Cavernous hemangiomas of the brain stem are usually discovered accidentally during evacuation of a hematoma, and successful surgical treatment of these lesions is seldom achieved. With the increasing use of magnetic resonance imaging, the presence of a cavernous hemangioma can be detected before surgery, allowing an elective surgical approach. We successfully removed pontomesencephalic cavernous hemangiomas from 2 patients and pontomedullary hemangiomas from 2 others. Elective surgery was performed with perioperative bimodal monitoring of somatosensory and auditory evoked potentials. Performing surgery soon after the hemorrhage minimizes the risk of additional postoperative neurological deficit, since surgical excision is facilitated when the hematoma is not completely organized. Pontine hemangiomas are approached via the 4th ventricle. Mesencephalic hemangiomas are removed by a midline supracerebellar approach when they are lateralized by using a subtemporal approach. The lesion can be removed through a small incision in the brain stem at the site of the lesion. The favorable results, which include marked improvement of preoperative neurological deficits and documentation of complete removal of the lesion by magnetic resonance imaging, support a more aggressive approach to the treatment of symptomatic cavernous hemangiomas of the brain stem. Further investigation of the natural history of these lesions is mandatory.

Download Full-text

Brain-Stem Auditory Evoked Potential Abnormalities With Unilateral Brain-Stem Lesions Demonstrated by Magnetic Resonance Imaging

Archives of Neurology ◽

10.1001/archneur.1989.00520390061017 ◽

1989 ◽

Vol 46 (3) ◽

pp. 295-299 ◽

Cited By ~ 22

Author(s):

O. N. Markand ◽

M. R. Farlow ◽

J. C. Stevens ◽

M. K. Edwards

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Stem ◽

Evoked Potential ◽

Auditory Evoked Potential ◽

Resonance Imaging ◽

Brain Stem Lesions ◽

Stem Lesions ◽

Unilateral Brain

Download Full-text

Symptomatic Chiari Malformation in Adults: A New Classification Based on Magnetic Resonance Imaging with Clinical and Prognostic Significance

Neurosurgery ◽

10.1227/00006123-199105000-00001 ◽

1991 ◽

Vol 28 (5) ◽

pp. 639-645 ◽

Cited By ~ 119

Author(s):

Prem K. Pillay ◽

Issam A. Awad ◽

John R. Little ◽

Joseph F. Hahn

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Brain Stem ◽

Chiari Malformation ◽

Prognostic Significance ◽

Type A ◽

Foramen Magnum ◽

Magnetic Resonance Imaging Scan ◽

Type B ◽

Resonance Imaging

Abstract Thirty-five consecutive adults with Chiari malformation and progressive symptoms underwent surgical treatment at a single institution over a 3-year period. All patients underwent magnetic resonance imaging scan before and after surgery. Images of the craniovertebral junction confirmed tonsillar herniation in all cases and allowed the definition of two anatomically distinct categories of the Chiari malformation in this age group. Twenty of the 35 patients had concomitant syringomyelia and were classified as Type A. The remaining 15 patients had evidence of frank herniation of the brain stem below the foramen magnum without evidence of syringomyelia and were labeled Type B. Type A patients had a predominant central cord symptomatology: Type B patients exhibited signs and symptoms of brain stem or cerebellar compression. The principal surgical procedure consisted of decompression of the foramen magnum, opening of the fourth ventricular outlet, and plugging of the obex. Significant improvement in preoperative symptoms and signs was observed in 9 of the 20 patients (45%) with syringomyelia (Type A), as compared to 13 of the 15 patients (87%) without syringomyelia (Type B). Postoperative reduction in syrinx volume was observed in 11 of the 20 patients with syringomyelia, including all 9 patients with excellent results. Magnetic resonance imaging has allowed a classification of the adult Chiari malformation in adults based on objective anatomic criteria, with clinical and prognostic relevance. The presence of syringomyelia implies a less favorable response to surgical intervention.

Download Full-text