Supratentorial Cavernous Malformations Involving the Corticospinal Tract and Sensory Motor Cortex: Treatment Strategies, Surgical Considerations, and Outcomes

Miran Skrap, Maria Caterina Vescovi, Giada Pauletto, Marta Maieron, Barbara Tomasino, Daniele Bagatto, Francesco Tuniz

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Cavernous malformations (CMs) are congenital malformations and may be located anywhere in the brain. We present a series of CMs located close to or inside of themotor-sensory cortex or corticospinal tract (CST)with clinical onset due to hemorrhage or mass effect. In such cases, surgery becomes an acceptable option. OBJECTIVE: To evaluate the role of diffusion tensor imaging (DTI), functional-magneticresonance imaging (fMRI), intraoperative neurophysiological monitoring, neuronavigation, and brain-mapping and the clinical results of surgical treatment of CMs in this critical location. METHODS: The study included 54 patients harboring 22 cortical and 32 deep locations. This series was distinct because in group I, where the DTI was not obtained, and in the group II, where this evaluation was performed. RESULTS: The postoperative permanent morbidity rate was 4% in the historical group for the deeper CMs, and there was no morbidity in the second group. DTI and fMRI permitted us to estimate the distance between the CMs and both the cortical activation cluster and the pyramidal tract. These data, in addition to intraoperative mapping and monitoring, made it necessary for us to perform a partial resection in 2 cases in the second series. CONCLUSION: CMs are congenital lesions and CST fibers can run directly on their surface. Integration of fMRI and DTI data with intraoperative functional monitoring and direct cortical and subcortical mapping are mandatory to accomplish an optimal resection, tailoring the best surgical approach to the acceptable morbidity.Asubtotal resection could be considered an option for deep locations.

Original languageEnglish
Pages (from-to)483-497
Number of pages15
JournalOperative Neurosurgery
Volume15
Issue number5
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • Cavernousmalformations,DTI
  • Insula
  • Neurophysiological monitoring,Microsurgical resection
  • Thalamus

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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