Microsurgical resection of supratentorial cerebral cavernomas

Abstract

Aim: More than two thirds of cerebral cavernomas are located supratentorially. The transsulcal approach without excision of the perilesional gliotic parenchyma and simple lesionectomy are keys to surgery on eloquent areas.

Material and methods: We present 11 supratentorial cerebral cavernomas operated between 2003 and 2007 with signs of seizures in six and focal neurological deficit in four cases. The age ranged from 19 years to 69 years with a mean of 40 years and the male/female ratio was 6:5. The mean follow-up was 26 months.

Results: All lesions were lobar and the size ranged between 18 and 48 mm. Four were located in eloquent areas and two were deeply seated. Total lesionectomy was performed in all without major complications. A gliotic hemosiderin ring was noted in 7 and resected in 5 of them. Postoperative outcome was improved in all patients with complete seizure control in four. Seizure control was partial in 2 of the cases without any recurrence or residual mass.

Conclusion: Asymptomatic cerebral cavernomas should be followed with regular MR scans. Symptomatic ones in noneloquent or accessible areas should be resected. Deeply situated cavernomas in eloquent areas should also be resected with the guidance of fMRI and stereotactic marking if available.