Neurosurgical Management of Brainstem Hemangioblastomas: A Single-Institution Experience with 116 Patients.

OBJECTIVE: Brainstem hemangioblastomas (HBs) are considered one of the most challenging lesions in surgical procedures. We present our institutional experience with 116 patients over a period of 20 years in the treatment of HBs. METHODS: We evaluated the results of microsurgical treatment and highlighted the management strategies. There were 60 male and 56 female patients including 13 cases with clinical evidence of von Hippel-Lindau disease. Tumors were solid in 99 cases and cystic in 17 cases. Tumors were small (≤2 cm) in 43 cases, large (2-4 cm) in 45 cases, and giant (≥4 cm) in 28 cases. RESULTS: Radical removal was achieved in 111 patients (95.7%), and incomplete removal was achieved in 5 cases (4.3%). The immediate postoperative mortality and morbidity were 7.8% and 17.2%, respectively. Detailed analyses of outcomes showed that surgical complications were related to some tumor characteristics. Follow-up study was available in 83 patients by Karnofsky performance scale scores. Most patients maintained their preoperative neurologic status. There were 17 patients with surgical disability who demonstrated a clear improvement with rehabilitation treatment. Worsening of neurologic deficits occurred in 2 patients. Ectopic recurrent lesions developed in 2 patients. CONCLUSIONS: Based on our experience, microsurgery is safe and effective, and excellent outcomes can be obtained for cystic or small tumors. We advocate early surgical intervention for sporadic HBs; giant solid HBs remain a challenge, and meticulous microsurgical technique and perioperative management are vital. Long-term monitoring also is recommended.

Language outcomes subsequent to treatment of brainstem tumour in childhood.

While the occurrence and management of brainstem tumours in children would not traditionally indicate potential direct structural impact on classical language centres, recent theories have implicated some involvement of the brainstem in a functional language and cognitive neural loop between the cerebellum and the cerebral hemispheres. Thus, the present paper explored the impact of treatment for brainstem tumour on the general and high-level language abilities of six children treated for brainstem tumour, in addition to phonological awareness skills. Group analysis revealed that children treated for brainstem tumour demonstrated intact language and phonological awareness abilities in comparison to an age- and gender-matched control group. Individual analysis revealed only one of six children treated for brainstem tumour revealed evidence of language disturbances, with an additional child demonstrating an isolated mildly reduced score on one phonological awareness task. Language deficits identified in a child treated with a combination of both radiotherapy and chemotherapy were noted in the high-level language area of lexical generation. Findings highlighted that no overt language disturbances were evident in children treated for brainstem tumour. However, further analysis into higher-level language skills in the present study indicated that both general and high-level language abilities require long-term monitoring in this population.

Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function.

OBJECTIVE: Intraoperative monitoring of transcranial motor evoked potentials (TcMEPs) has been investigated recently as a means of preventing motor deficits associated with resection of intramedullary spinal cord tumors (IMSCTs). In this study, we hypothesized that changes in the intraoperative MEPs during tumor resection correlate with postoperative motor function deficits. METHODS: A retrospective record review was conducted for 28 patients who underwent resection of an IMSCT using myogenic or muscle-recorded TcMEPs during a 44-month period. Intraoperative MEP recordings and results from preoperative, immediate postoperative, and subsequent follow-up neurological examinations were analyzed. RESULTS: Of the 28 patients who underwent resection of an IMSCT using TcMEPs, MEP changes occurred in 13 patients (46%). Impaired motor conduction was detected by changes in pattern and duration of the MEP waveform morphology (polyphasic to biphasic in 9 patients and polyphasic to biphasic to loss of MEP response in 5 patients, 1 patient demonstrated both changes) and by an increase in voltage threshold (median, 175 V; range, 100-225 V; n = 22 extremities). Alterations in morphology and reduction in duration of the MEP response persisted despite significant increases in stimulation voltage. In 12 patients, reductions in the complexity and/or loss of the TcMEP waveform correlated with motor grade loss in the immediate postoperative period (P < 0.0001), at discharge (P < 0.001), and at follow-up (P < 0.001). The decrease in the duration of the response correlated with motor grade loss immediately after surgery (P < 0.001), at discharge (P < 0.0001), and at follow-up (P < 0.005). CONCLUSION: These results support the application of distal muscle-recorded TcMEPs to predict the occurrence and severity of postoperative motor deficits during resection of IMSCTs. Attention to such quantitative intraoperative monitoring data may help to minimize postoperative motor deficits by avoiding or correcting excessive spinal cord manipulation and modifying surgical technique during tumor resection.