Microsurgical removal of supratentorial and cerebellar cavernous malformations: what has changed? A single institution experience.

• Two consecutive series from the same Neurosurgical Institute revealed changes in the surgical management of cavernous malformations. • Reduced rate of microsurgical removal of non-eloquent supratentorial cavernomas. • Wider indication for microsurgical removal of supratentorial eloquent cavernomas due to low surgical morbidity. • Supratentorial deep cavernomas showed high risk for post-operative morbidity. • Cerebellar cavernous malformation showed a low risk of post-operative morbidity. Features associated with a safe surgical resection of cerebral cavernous malformations (CMs) are still not clear and what is needed to achieve this target has not been defined yet. Clinical presentation, radiological features and anatomical locations were assessed for patients operated on from January 2008 to January 2018 for supratentorial and cerebellar cavernomas. Supratentorial CMs were divided into 3 subgroups (non-critical vs. superficial critical vs. deep critical). The clinical outcome was assessed through modified Rankin Scale (mRS) and was divided into favorable (mRS 0–1) and unfavorable (mRS ≥ 2). Post-operative epilepsy was classified according to the Maraire Scale. A total of 144 were considered eligible for the current study. At 6 months follow-up the clinical outcome was excellent for patients with cerebellar or lobar CMs in non-critical areas (mRS ≤ 1: 91.1 %) and for patients with superficial CMs in critical areas (mRS ≤ 1: 92.3 %). Patients with deep-seated suprantentorial CMs showed a favorable outcome in 76.9 %. As for epilepsy 58.5 % of patients presenting with a history of epilepsy were free from seizures and without therapy (Maraire grade I) at last follow-up (mean 3.9 years) and an additional 41.5 % had complete control of seizures with therapy (Maraire grade II). Surgery is safe in the management of CMs in non-critical but also in critical supratentorial locations, with a caveat for deep structures such as the insula, the basal ganglia and the thalamus/hypothalamus. [ABSTRACT FROM AUTHOR]