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Treatment of cavernous malformations in supratentorial eloquent areas: experience after 10 years of patient-tailored surgical protocol

  • Jose L. Sanmillan
  • Pablo Lopez-Ojeda
  • Isabel Fernández-Conejero
  • Alejandro Fernández-Coello
  • Gerard Plans
  • Yara Ali-Ciurana
  • Andreu Gabarrós
Original Article - Neurosurgery general
  • 19 Downloads
Part of the following topical collections:
  1. Neurosurgery general

Abstract

Background

Eloquent area surgery has become safer with the development of intraoperative neurophysiological monitoring and brain mapping techniques. However, the usefulness of intraoperative electric brain stimulation techniques applied to the management and surgical treatment of cavernous malformations in supratentorial eloquent areas is still not proven. With this study, we aim to describe our experience with the use of a tailored functional approach to treat cavernous malformations in supratentorial eloquent areas.

Methods

Twenty patients harboring cavernous malformations located in supratentorial eloquent areas were surgically treated. Individualized functional approach, using intraoperative brain mapping and/or neurophysiological monitoring, was utilized in each case. Eleven patients underwent surgery under awake conditions; meanwhile, nine patients underwent asleep surgery.

Results

Total resection was achieved in 19 cases (95%). In one patient, the resection was not possible due to high motor functional parenchyma surrounding the lesion tested by direct cortical stimulation. Ten (50%) patients presented transient neurological worsening. All of them achieved total neurological recovery within the first year of follow-up. Among the patients who presented seizures, 85% achieved seizure-free status during follow-up. No major complications occurred.

Conclusions

Intraoperative electric brain stimulation techniques applied by a trained multidisciplinary team provide a valuable aid for the treatment of certain cavernous malformations. Our results suggest that tailored functional approach could help surgeons in adapting surgical strategies to prevent patients’ permanent neurological damage.

Keywords

Brain mapping Neurophysiological monitoring Cavernous malformations Cerebrovascular Eloquent area surgery 

Abbreviations

EBS

Electric brain stimulation

CM

Cavernous malformation

DTI

Diffusion tensor imaging

fMRI

Functional magnetic resonance imaging

IONM

Intraoperative neurophysiological monitoring

MRI

Magnetic resonance imaging

Notes

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neurosurgery DepartmentHospital Universitari de BellvitgeBarcelonaSpain
  2. 2.Neurophysiology DepartmentHospital Universitari de BellvitgeBarcelonaSpain
  3. 3.Universitat de BarcelonaBarcelonaSpain

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