Treatment of cavernous malformations in supratentorial eloquent areas: experience after 10 years of patient-tailored surgical protocol.

Abstract:

BACKGROUND:Eloquent area surgery has become safer with the development of intraoperative neurophysiological monitoring and brain mapping techniques. However, the usefulness of intraoperative electric brain stimulation techniques applied to the management and surgical treatment of cavernous malformations in supratentorial eloquent areas is still not proven. With this study, we aim to describe our experience with the use of a tailored functional approach to treat cavernous malformations in supratentorial eloquent areas. METHODS:Twenty patients harboring cavernous malformations located in supratentorial eloquent areas were surgically treated. Individualized functional approach, using intraoperative brain mapping and/or neurophysiological monitoring, was utilized in each case. Eleven patients underwent surgery under awake conditions; meanwhile, nine patients underwent asleep surgery. RESULTS:Total resection was achieved in 19 cases (95%). In one patient, the resection was not possible due to high motor functional parenchyma surrounding the lesion tested by direct cortical stimulation. Ten (50%) patients presented transient neurological worsening. All of them achieved total neurological recovery within the first year of follow-up. Among the patients who presented seizures, 85% achieved seizure-free status during follow-up. No major complications occurred. CONCLUSIONS:Intraoperative electric brain stimulation techniques applied by a trained multidisciplinary team provide a valuable aid for the treatment of certain cavernous malformations. Our results suggest that tailored functional approach could help surgeons in adapting surgical strategies to prevent patients' permanent neurological damage.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Sanmillan JL,Lopez-Ojeda P,Fernández-Conejero I,Fernández-Coello A,Plans G,Ali-Ciurana Y,Gabarrós A

doi

10.1007/s00701-018-3644-3

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

1963-1974

issue

10

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-018-3644-3

journal_volume

160

pub_type

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