Surgically treated intrapontine cavernomas: A clinical analysis

Introduction: Pre-surgical post-hemorrhage condition and cavernoma localization may be predictors of postsurgical outcome and influence the therapy concept. Patients and methods: Out of 60 intracranial cavernous angiomas operated at our institution between 1986 and 1996, 27 were located within the pons. There were 14 female and 13 male patients with a mean age of 41 years (9-64), operated within 1 to 24 months after one to four hemorrhage episodes. Results: The lesions were removed microsurgically without rebleeding recurrency. On early postoperative control, 19 patients showed some deterioration or aggravation of pre-existing symptoms, 5 were unchanged. 3 patients showed an improvement of pre-existing symptoms. 9 patients were treated by the hypoglossal-facial reanimation during the follow-up period, one by a plastic procedure. At the follow-up examination (12 to 60 months postoperatively), all patients showed clinical improvement at various extent: 3 patients presented without any deficits, 20 patients had evident improvement of their neurological deficits and only in 4 patients additional morbidity persisted in comparison to the preoperative neurological state; the latter are independent of institutional care. Of all the patients with postoperative facial paralysis 8 showed a preoperative facial palsy or combined facial and abducens palsies, 3 showed abducens palsies. Conclusions: Long-term outcome of post-hemorrhage pontine cavernomas by surgical therapy appears favourable because continuous recovery may be anticipated with long-term improvement of the presurgical status in the majority of the patients. Presurgical affection of the sixth or seventh cranial nerves due to cavernoma hemorrhage indicate a serious nuclear lesion and predict the likelihood for necessary postsurgical facial nerve reconstruction. A clinically apparent bleeding from an intrapontine cavernoma presents an indication for surgical treatment in order to minimize the risk for further deterioration from further hemorrhages.