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Risks of surgical management for cavernous malformations of the nervous system.
- Source :
-
Neurosurgery [Neurosurgery] 1998 Jun; Vol. 42 (6), pp. 1220-7; discussion 1227-8. - Publication Year :
- 1998
-
Abstract
- Objective: As more information evolves regarding the natural history of cavernous malformations (CMs), the risks of operative intervention must be balanced against nonoperative management. In an attempt to better delineate the surgical risks for operable CMs, we undertook a retrospective analysis of 94 patients with 97 CMs surgically excised at the Massachusetts General Hospital.<br />Methods: Data regarding surgical complications and outcome measures, including neurological status and seizure outcome, were analyzed.<br />Results: The incidence of transient neurological morbidity was 20.6%, but only 4 of the 97 operations (4.1%) resulted in persistent disabling neurological complications and 2 (2.1 %) in nondisabling deficits. There was no operative mortality. Brain stem lesions (n=14) were associated with the highest incidence of neurological complications, both transient and persistent (odds ratio, 4.8; 95% confidence interval, 1.5-15.7). The overall neurological outcome was excellent or good in 89.7% of all lesions: 96.8% of lobar CMs (n=63), 64.2% of brain stem CMs (n=14), 87.5% of cerebellar CMs (n=8), 100% of cranial nerve CMs (n=4), and 75% of spinal cord CMs (n=8). Patients with brain stem and spinal cord CMs were in poorer preoperative neurological condition than were patients with CMs in other locations and therefore had a significantly reduced level of function after surgery (P < 0.01). There was improvement in 35.7% of the patients with brain stem lesions and 62.5% of the patients with spinal cord lesions after surgery. In the 38 patients presenting with seizures, 97% were seizure-free after surgery.<br />Conclusion: The risks of operative management of CMs varies based on location. When evaluating patients with operable CMs for surgery, the incidence of complications as well as final neurological outcome should be carefully weighed against the existing knowledge of the natural history of lesions managed expectantly.
- Subjects :
- Adolescent
Adult
Aged
Arteriovenous Malformations diagnosis
Arteriovenous Malformations physiopathology
Central Nervous System physiopathology
Child
Child, Preschool
Female
Humans
Incidence
Magnetic Resonance Imaging
Male
Middle Aged
Nervous System Diseases epidemiology
Nervous System Diseases etiology
Nervous System Diseases physiopathology
Postoperative Complications
Retrospective Studies
Risk Factors
Treatment Outcome
Arteriovenous Malformations surgery
Central Nervous System blood supply
Subjects
Details
- Language :
- English
- ISSN :
- 0148-396X
- Volume :
- 42
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 9632179
- Full Text :
- https://doi.org/10.1097/00006123-199806000-00007