Management of Intracranial Cavernous Malformation: A Retrospective Analysis of 76 Consecutive Cases

OBJECTIVE: To establish a treatment guideline for intracranial cavernous malformation, the authors analyzed the clinical features, treatment modality, complications, and late outcomes in 76 consecutive cases (45 microsurgical resections, 30 stereotactic radiosurgeries, one microsurgery followed by radiosurgery) managed at the Yonsei University Medical Center from 1985 to 1998. RESULTS: Among 104 lesions in 76 patients, 64(61.5%) lesions were supratentorial and 40(38.5%) infratentorial. Hemorrhage was the most common presentation(31 patients, 40.8%), followed by generalized seizure(15 patients, 19.7%). Fifteen(19.7%) patients had mixed presentation with generalized seizure and hemorrhage, while 9(11.9%) patients presented focal deficits. The remaining 6(7.9%) patients had headache or incidental lesion. Almost all infratentorial lesions(92.5%) were managed with radiosurgery, and 65.6% of supratentorial lesions with microsurgery. The average follow-up period was 14.6 months for the microsurgery group and 32 months for the radiosurgery group. The overall outcome was good in 68(89.5%), fair in 6(7.9%), poor in 1(1.3%), and dead in 1(1.3%). Total microsurgical resection and symptomatic cure rate was 95.6%. Two lesion were incompletely resected. One lesion was followed by radiosurgery and the other was followed by reoperation. Only 38.5% of lesions with radiosurgery were shrunken. CONCLUSION: Microsurgical removal is effective for lesions in the non-eloquent area, or with recurrent hemorrhages and seizures. Although radiosurgery could be considered for lesions with multiplicity in the eloquent or deep-seated area, further study for the radiosurgical effect on cavernous malformations is required.

Percutaneous radiofrequency Thermal Rhizotomy for Trigeminal Neuralgia

This study was performed to analyze the long-term results of percutaneous radiofrequency thermal rhizotomy for trigeminal neuralgia. The authors analyzed 193 cases with trigeminal neuralgia which underwent percutaneous radiofrequency thermal rhizotomy documented from March, 1973 to December, 1992. The patients(122 cases) were followed-up for average 6.1 years. Initial pain relief was obtained in 97.4% of the patients with percutaneous thermal rhizotomy. Recurrence of trigeminal pain after surgery was observed in 47 cases(38.5%) during the follow-up period. Surgical complications were as follows; masseter weakness in 7 patients, oculomotor palsy in 1 patient, weakness of the corneal reflex in 10 patients(1 of them requested ocular management) for keratitis, and anesthesia dorosa in 2 patients. These results suggest that percutoneous radiofrequency thermal rhizotomy is a useful therapeutic tool to relieve pain immediately an safely in trigeminal neuralgia.

Somatosensory Evoked Potentials in Aneurysmal Subarachnoid Hemorrhage with Delayed Cerebral Ischemic Deterioration

Somatosensory evoked potentials(SEPs) reflect the functional integrity of the central neural pathways, and as such may be used to assess function that remains during variety of cerebral insults. To evaluate the utility of SEPs during cerebral ischemic deterioration due to aneurysmal subarachnoid hemorrhage, SEPs were measured in 43 patients with subarachnoid hemorrhage, among them 24 patients had no cerebral ischemic deterioration(group 1) and 19 patients had cerebral ischemic deterioration(group 2). In group 1, central conduction time(CCT) were measured on the day of admission(CCT1), the seventh day(CCT2), and the twenty-first day(CCT3) after aneurysmal rupture. In group 2, CCT were measured on the day of admission(CCT1), during(CCT2) and after resolution(CCT3) of cerebral ischemic deterioration. CCT2 of the both cerebral hemispheres were different significantly between two group(p=0.01). In group 2, there was stastically significantly difference between CCT1 and CCT2(p<0.01), and significant correlation between clinical grade and CCT was noted, especially in grade III, and IV. Therefore it is suggested that the central latencies of the SEPs are seemed to be a sensitive tools as indicators of the onset and extent of a cerebral ischemic deterioration due to aneurysmal subarachnoid hemorrhage.