Microsurgical Treatment and Outcome of Pediatric Supratentorial Cerebral Cavernous Malformation

Noh, Jung-Hoon; Cho, Kyung Rae; Yeon, Je Young; Seol, Ho Jun; Shin, Hyung Jin

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자료유형: 학술저널

저자정보: Noh, Jung-Hoon (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Cho, Kyung Rae (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Yeon, Je Young (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Seol, Ho Jun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) Shin, Hyung Jin (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제56권 제3호

발행연도: 2014.1

수록면: 237 - 242 (6page)

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Objective : The purpose of this study was to investigate the clinical features and outcomes of pediatric cavernous malformation (CM) in the central nervous system. Methods : Twenty-nine pediatric patients with supratentorial CM underwent microsurgical excision. In selected cases, transparent tubular retractor system (TTRS) was used to reduce retraction injury and intraoperative neuromonitoring (IONM) was held to preserve functioning cortex. Patients' demographics and symptoms were reviewed and surgical outcomes were discussed. Results : The main initial clinical manifestations included the following : seizures (n=13, 45%), headache (n=7, 24%), focal neurological deficits (n=3, 10%), and an incidental finding (n=6, 21%). Overt hemorrhage was detected in 7 patients (24%). There were 19 children (66%) with a single CM and 10 (34%) children with multiple CMs. In 7 cases with deep-seated CM, we used a TTRS to minimize retraction. In 9 cases which location of CM was at eloquent area, IONM was taken during surgery. There was no major morbidity or mortality after surgery. In the 29 operated children, the overall long-term results were satisfactory : 25 (86%) patients had no signs or symptoms associated with CMs, 3 had controllable seizures, and 1 had mild weakness. Conclusion : With the assistance of neuronavigation systems, intraoperative neuromonitoring, and TTRS, CMs could be targeted more accurately and excised more safely. Based on the satisfactory seizure outcome achieved, complete microsurgical excision in children is recommended for CMs presenting with seizures but removal of hemosiderin-stained areas seems to be unnecessary.

#Cavernous malformation #Hemosiderin deposit #Neuronavigation #Transparent tubular retractor

참고문헌 (34)

참고문헌 신청

Acciarri N / 2009 / Cavernous malformations of the central nervous system in the pediatric age group / Pediatr Neurosurg 45:81~104

Aiba T / 1995 / Natural history of intracranial cavernous malformations / J Neurosurg 83:56~59

Baumann CR / 2007 / Seizure outcome after resection of supratentorial cavernous malformations : a study of 168 patients / Epilepsia 48:559~563

Baumann CR / 2006 / Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin-stained brain also is removed / Epilepsia 47:563~566

Casazza M / 1996 / Supratentorial cavernous angiomas and epileptic seizures : preoperative course and postoperative outcome / Neurosurgery 39:26~32