Surgical Strategy for Brainstem Cavernous Angioma Especially Based on the Timing of Surgery

The surgical procedure for a brainstem lesion must be carefully considered because of the critical neurological functions of the brainstem. We have surgically treated brainstem cavernous angioma after bleeding without significant postoperative morbidity, because the boundary between the angioma and normal brain tissue is generally well demarcated by preceding hemorrhages. However, because the angioma tissues are often destroyed by hemorrhage, care must be taken not to leave any pieces of the angioma tissue. To reduce the risk of morbidity, surgeons must investigate carefully when performing the operation. We analyze the surgical results and pathological findings of nine cases of symptomatic brainstem cavernous angiomas, and discuss the various surgical strategies especially based on the timing of surgery.