Efficacy of microsurgical management and gamma knife radiosurgery on brain stem cavernous malformations

Objective To explore the efficacy ofmicrosurgery and gamma knife treatment on brainstem cavernous malformations.Methods Retrospective analysis was performed on the clinical data of 15 patients with brainstem cavernous malformations treated by microsurgery and 22 patients by gamma knife in our hospital from January 2002 to December 2011.The clinical symptom improvement,scores of Glasgow Outcome Scale,scores of Karnofsky Performance Scale and scores of National Institutes of Health Stroke Scale before and after treatment were observed and compared between the two groups.Results Patients in the micro-surgery group enjoyed the following results:one patient with pontine lesion had residual postoperation; no re-bleeding or death was noted; two had irreversible neurological dysfunction; clinical symptoms improved in 11 patients (73.3％); the postoperative scores of Glasgow Outcome Scale and Karnofsky Performance Scale increased 0.20 and 6.6 as compared with the preoperative ones; The postoperative scores of National Institutes of Health Stroke Scale decreased 1.20 as compared with the preoperative ones.Patients in Gamma Knife group enjoyed the following results:the lesions of two patients increased due to re-bleeding; three had perifocal brain edema; no death was noted;the clinical symptoms improved in 9 patients (40.9％); the postoperative scores of Glasgow Outcome Scale and Karnofsky Performance Scale increased 0.05 and 1.82 as compared with the preoperative ones; the postoperative scores of National Institutes of Health Stroke Scale decreased 0.82 as compared with the preoperative ones.Conclusion Micro-surgery may be more effective than Gamma Knife in treating brainstem cavernous malformations; however,patients with non-surgical conditions or refusing surgery could choose Gamma Knife treatment; gamma knife treatment should be cautiously chosen. Key words: Brain stem;  Cavernous malformation;  Microsurgery;  Gamma knife