The Microsurgical Treatment of Brainstem Cavernous Malformations in the Pediatric Population

Sunday, May 5, 2024

3:51 PM – 3:53 PM CT

Location: S405b

Presenting Author(s)

Stefan W. Koester, n/a

Medical Student
Vanderbilt University School of Medicine
Nashville, TN, US

Co-Author(s)

Joshua Catapano, MD

Neurosurgeon
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, 85013, Arizona, USA
Phoenix, Arizona, United States
JH

Joelle N. Hartke, MD

Resident
Barrow Neurological Institue
Phoenix, Arizona, United States
Michael T. Lawton, MD

Professor of Neurosurgery
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, 85013, Arizona, USA
Phoenix, AZ, US
JM

John Mailolo, BS

Medical Student
Barrow Neurological Institue, United States
Redi Rahmani, MD

Fellow
Barrow Neurological Institue
Penfield, New York, United States
Lea Scherschinski, MD

Postdoctoral Fellow
Barrow Neurological Institue
Phoenix, AZ, US

Disclosure(s):

Stefan W. Koester, n/a: No financial relationships to disclose

Michael T. Lawton, MD: No financial relationships to disclose

Lea Scherschinski, MD: No financial relationships to disclose

Introduction: Brainstem cavernous malformations (BSCMs) are rare lesions that pose surgical challenges due to depth and eloquence of surrounding structures. Treatment guidelines for BSCMs in the pediatric population are lacking, but are especially crucial to consider due to potential impairment in lifetime longevity and future worsening quality of life. Our aim is to assess our single-institution cohort in the microsurgical treatment of pediatric BSCMs to characterize post-surgical functional outcomes.

Methods: Patients undergoing resection of their BSCM at a single center from 9/2010 to 8/2022 were assessed. Inclusion criteria consisted of adequate information regarding functional status at follow-up. The primary outcome included poor functional outcome as defined by modified Rankin Scale (mRS) > 2 and secondary outcomes included occurrence of mortality and reoperation.

Results: A total of 15 patients were included in the final analysis with a median age of 14.2 (range 7 – 17.4), of which 8 (53%) were female. Pre-operative hemorrhage was experienced in 14 patients, of which 4 patients had multiple hemorrhages and the median time from bleed to surgery was 36 days (IQR 13.7 – 226). By location, 3 (20%) patients’ BSCMs were located in the midbrain, 8 (53%) in the pons, and 4 (27%) in the medulla. The median pre-operative mRS was 2 (IQR 1-2) while the final mRS after surgery was 1 (IQR 1 - 2.5). An mRS of 5 or 6 was not observed at follow-up. Functional status improved in 5 (33%) patients, remained stable in 6 (40%) patients, and worsened in 4 (27%) patients. 1 (7%) person experienced an intra-operative complication and 4 (27%) patients were re-operated.

Conclusion : Given the longer life expectancy of children and the associated morbidity and mortality of ruptured BSCMs, microsurgical treatment should be considered an effective treatment option for improving or stabilizing neurological deficits in children suffering from BSCMs.