Hematomas and Cavernous Angiomas of the Brain Stem: Diagnostic Criteria and a Differential Approach to Treatment

Gavryushins └., Konovalov └., Huhlaeva ┼., Kornienko V., Shishkina L., Lukyanov V.

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The research goal was to elaborate a differential approach to diagnosis and treatment of cases with ôcavernous angiomas (CA) of the brain stemö.

Material and Methods. There were 153 cases, examined in 1986-2004; 122 of them were operated; 41 patients were treated conservatively.

Results. CT and MRI images were compared with intraoperative data and results of histological studies. It allowed to determine two versions of the disease substrate in pathology, usually known as CA of the brain stem.
1. Hematomas without MRI signs of malformations (a. subacute; b. chronic). The rate of hemorrhages (patient/year) was 4%; 60% of cases had a state, characterized by a score of 30-50 (the Glasgow Coma Scale), which was conditioned by large hematomas (>3 cm3) and accompanying edema.
2. Malformations, mainly CA (a. with hemorrhagic signs; b. without hemorrhagic signs). The rate of hemorrhages (patient/year) was 8.3%. A mean score, obtained in estimation of a state severity, was 60-80 (the Glasgow Coma Scale).
A character of a pathologic process was the main prognostic factor of an operation outcome. Immediate postoperative regression of neurological symptoms was watched in 77% of cases. Removal of CA at a non-hemorrhagic stage led to their regression only in 5% of patients; on the contrary, their augmentation was watched in 73% of cases.

Conclusions. The disease substrate in CA of the brain stem is heterogeneous. Surgical treatment is indicated in subacute and chronic hematomas (>3 cm3), as well as in CA at a hemorrhagic stage. The optimum operation time is a subacute period of hemorrhage (the second-forth week). In case of CA at a non-hemorrhagic stage, surgical treatment is a method of choice only in constant aggravation of a clinical picture. Conservative treatment is recommended in hemorrhages of less than 3 cm3, characterized by minimum neurological manifestations.