{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:46:11Z","timestamp":1783773971391,"version":"3.55.0"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The goal of this study was to evaluate surgical outcomes of pediatric brainstem cavernous malformations (CMs) and identify the risk factors associated with postoperative full recovery and rebleeding.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The clinical charts and radiographs from a series of 52 pediatric patients (37 male and 15 female; mean age 12.2 years; range 1\u201317 years) who underwent surgery for brainstem CMs between 1996 and 2011 were reviewed. Follow-up evaluation measures were obtained retrospectively. Neurological function was evaluated using the modified Rankin Scale (mRS) score.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The lesion locations among the 52 patients included the midbrain (n = 7, 13.5%), pons (n = 38, 73.1%), and medulla (n = 7, 13.5%). The mean duration of symptoms was 18.5 months, and the preoperative annual hemorrhage and rebleeding rates were 12.3% and 32.5% per patient-year, respectively. The mean lesion size was 2.1 cm. Gross-total resection without surgery-related death was achieved in 49 patients (94.2%). Immediate postoperative reduced neurological function was observed in 17 patients (32.7%). Surgical morbidities developed in 25 patients (48.1%) and remained in 11 patients (21.2%) after 7.9 years of follow-up. The mean mRS scores at admission, discharge after surgery, 3 and 6 months postsurgery, and recent evaluation were 2.0, 2.3, 2.0, 1.5, and 1.0, respectively. The postoperative mRS scores at 6 months (p &lt; 0.001) and on recent evaluation (p &lt; 0.001) were significantly lower than those at admission. Postoperative rebleeding occurred in 2 patients, and the postoperative annual rebleeding rate was 0.5% per patient-year. By the most recent evaluation, 10 patients (19.2%) had achieved full recovery and all patients were either improved (n = 32, 61.5%) or unchanged (n = 20, 38.5%). The adverse predictors for full recovery included age \u2265 12 years (HR 0.230, p = 0.021), \u2265 2 preoperative hemorrhages (HR 0.124, p = 0.048), and poor preoperative status (HR 0.197, p = 0.040). An HR &lt; 1 predicted poor complete recoveries. The single risk factor predicting postoperative rebleeding was incomplete resection (\u03c7<jats:sup>2<\/jats:sup> = 4.340, p = 0.037).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Fair outcomes for pediatric brainstem CMs could be obtained through surgery, but only a few patients achieved full recovery. Thus, to minimize surgical morbidity, surgical planning must be tailored to individual patients in all cases in which an operation is warranted. Complete resection must be attempted to reduce the risk of postoperative rebleeding. The predictors associated with complete postoperative recovery were referential for determining treatment.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.2.peds13536","type":"journal-article","created":{"date-parts":[[2014,3,28]],"date-time":"2014-03-28T23:01:49Z","timestamp":1396047709000},"page":"484-502","source":"Crossref","is-referenced-by-count":49,"title":["Surgical management of pediatric brainstem cavernous malformations"],"prefix":"10.3171","volume":"13","author":[{"given":"Da","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Yu","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin-Ru","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-Jun","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Ting","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1227\/NEU.0b013e3181f8d1b2","article-title":"Cavernous malformations of the brainstem presenting in childhood: surgical experience in 40 patients","volume":"67","author":"Abla","year":"2010"},{"key":"b2-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1227\/NEU.0b013e3181ff9cde","article-title":"Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients","volume":"68","author":"Abla","year":"2011"},{"key":"b3-peds13536","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.wneu.2012.06.011","article-title":"Brainstem cavernoma surgery: the state of the art","volume":"80","author":"Abla","year":"2013"},{"key":"b4-peds13536","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1159\/000209283","article-title":"Cavernous malformations of the central nervous system in the pediatric age group","volume":"45","author":"Acciarri","year":"2009"},{"key":"b5-peds13536","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3222","DOI":"10.1161\/STROKEAHA.108.515544","article-title":"Hemorrhage from cavernous malformations of the brain: definition and reporting standards","volume":"39","author":"Al-Shahi Salman","year":"2008"},{"key":"b6-peds13536","series-title":"Arq Neuropsiquiatr","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1590\/0004-282X20130006","article-title":"Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases","volume":"71","author":"Amato","year":"2013"},{"key":"b7-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1097\/00006123-199806000-00007","article-title":"Risks of surgical management for cavernous malformations of the nervous system","volume":"42","author":"Amin-Hanjani","year":"1998"},{"key":"b8-peds13536","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1161\/01.STR.0000258355.23810.c6","article-title":"Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis","volume":"38","author":"Banks","year":"2007"},{"key":"b9-peds13536","series-title":"J Mt Sinai Hosp N Y","first-page":"119","article-title":"Hemangioma of the pons; case report and review of the literature","volume":"17","author":"Bergman","year":"1950"},{"key":"b10-peds13536","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/BF01418515","article-title":"Microsurgery of deep-seated cavernous angiomas: report of 26 cases","volume":"108","author":"Bertalanffy","year":"1991"},{"key":"b11-peds13536","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"458","DOI":"10.3171\/2009.6.PEDS0923","article-title":"Management of pediatric brainstem cavernous malformations: experience over 20 years at the Hospital for Sick Children. Clinical article","volume":"4","author":"Bhardwaj","year":"2009"},{"issue":"6 Suppl","key":"b12-peds13536","series-title":"J Neurosurg","first-page":"429","article-title":"Cavernous malformations of the brainstem in infants. Report of two cases and review of the literature","volume":"104","author":"Braga","year":"2006"},{"key":"b13-peds13536","series-title":"BNI Q","first-page":"20","article-title":"The two-point method: evaluating brain stem lesions","volume":"12","author":"Brown","year":"1996"},{"issue":"5 Suppl","key":"b14-peds13536","series-title":"J Neurosurg","first-page":"379","article-title":"Incidence of cavernoma development in children after radiotherapy for brain tumors","volume":"106","author":"Burn","year":"2007"},{"key":"b15-peds13536","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1007\/s00701-008-0008-4","article-title":"Post-operative remnants of brainstem cavernomas: incidence, risk factors and management","volume":"150","author":"Cenzato","year":"2008"},{"key":"b16-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1227\/NEU.0b013e3182077531","article-title":"Surgical strategies in treating brainstem cavernous malformations","volume":"68","author":"Chen","year":"2011"},{"key":"b17-peds13536","series-title":"Neurol Sci","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s10072-009-0157-0","article-title":"Treatment and outcome of children with cerebral cavernomas: a survey on 32 patients","volume":"31","author":"Consales","year":"2010"},{"key":"b18-peds13536","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1007\/BF01411054","article-title":"Cavernomas of the central nervous system in children. A report of 22 cases","volume":"138","author":"Di Rocco","year":"1996"},{"key":"b19-peds13536","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1159\/000121233","article-title":"Cavernous angiomas of the brain stem in children","volume":"27","author":"Di Rocco","year":"1997"},{"key":"b20-peds13536","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1007\/s003810050153","article-title":"Surgically resected brain stem cavernous angioma in an infant","volume":"13","author":"Endo","year":"1997"},{"key":"b21-peds13536","series-title":"Acta Neurochir Suppl (Wien)","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/978-3-7091-9183-5_7","article-title":"Pontine-mesencephalic cavernomas: indications for surgery and operative results","volume":"53","author":"Fahlbusch","year":"1991"},{"key":"b22-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1227\/01.NEU.0000159644.04757.45","article-title":"Brainstem cavernomas: long-term results of microsurgical resection in 52 patients","volume":"56","author":"Ferroli","year":"2005"},{"key":"b23-peds13536","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/S1042-3680(18)30182-7","article-title":"Management of cavernous malformations in the pediatric population","volume":"10","author":"Frim","year":"1999"},{"key":"b24-peds13536","series-title":"Childs Nerv Syst","first-page":"564","article-title":"Supra- and infratentorial multiple cavernous angiomas in an infant: report with MR evaluation of an unusual case","volume":"12","author":"Fujii","year":"1996"},{"key":"b25-peds13536","series-title":"Acta Neurol (Napoli)","first-page":"132","article-title":"Rapid growth of a brain-stem cavernous angioma","volume":"15","author":"Gangemi","year":"1993"},{"key":"b26-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E805","DOI":"10.1227\/01.NEU.0000343668.44288.18","article-title":"Brainstem cavernous malformations","volume":"64","author":"Gross","year":"2009"},{"key":"b27-peds13536","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.wneu.2012.04.002","article-title":"Brainstem cavernous malformations: 1390 surgical cases from the literature","volume":"80","author":"Gross","year":"2013"},{"key":"b28-peds13536","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"367","DOI":"10.3171\/2013.7.PEDS13126","article-title":"Resection of supratentorial lobar cavernous malformations in children. Clinical article","volume":"12","author":"Gross","year":"2013"},{"key":"b29-peds13536","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/S0022-3476(50)80010-0","article-title":"Spontaneous hemorrhage from a hemangioma of the pons","volume":"37","author":"Grotts","year":"1950"},{"key":"b30-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1227\/01.NEU.0000335158.11692.53","article-title":"Symptomatic brainstem cavernomas","volume":"64","author":"Hauck","year":"2009"},{"key":"b31-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1227\/00006123-199011000-00018","article-title":"Surgical resection of intrinsic brain stem lesions: an overview","volume":"27","author":"Heffez","year":"1990"},{"key":"b32-peds13536","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"607","DOI":"10.3171\/jns.2004.101.4.0607","article-title":"Postoperative evaluation of microsurgical resection for cavernous malformations of the brainstem","volume":"101","author":"Kikuta","year":"2004"},{"key":"b33-peds13536","series-title":"Neurosurgery","first-page":"47","article-title":"Natural history of brainstem cavernous malformations","volume":"48","author":"Kupersmith","year":"2001"},{"key":"b34-peds13536","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1007\/s003810050110","article-title":"Cerebral cavernous angiomas: an atypical case in infancy","volume":"13","author":"Lanzi","year":"1997"},{"key":"b35-peds13536","series-title":"Neurochirurgie","first-page":"319","article-title":"[Brain stem cavernomas in children. Nine case reports and literature review.]","volume":"48","author":"Lena","year":"2002"},{"key":"b36-peds13536","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"996","DOI":"10.3171\/2013.7.JNS13462","article-title":"Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations. Clinical article","volume":"119","author":"Li","year":"2013"},{"key":"b37-peds13536","series-title":"Tohoku J Exp Med","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1620\/tjem.166.259","article-title":"Clinical analysis of ten cases with surgically treated brain stem cavernous angiomas","volume":"166","author":"Mizoi","year":"1992"},{"key":"b38-peds13536","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1771","DOI":"10.1111\/epi.12342","article-title":"Long-term functional outcomes and their predictors after hemispherectomy in 115 children","volume":"54","author":"Moosa","year":"2013"},{"key":"b39-peds13536","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3171\/jns.1999.90.1.0050","article-title":"Cavernous malformations of the brainstem: experience with 100 patients","volume":"90","author":"Porter","year":"1999"},{"key":"b40-peds13536","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1177\/0883073812457459","article-title":"Brainstem cavernoma hemorrhage during pregnancy in a 15-year-old: description of a unique neurosurgical approach","volume":"28","author":"Ranger","year":"2013"},{"key":"b41-peds13536","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1007\/BF01403199","article-title":"Surgical treatment of cavernous angioma involving the brainstem and review of the literature","volume":"113","author":"Sakai","year":"1991"},{"key":"b42-peds13536","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"825","DOI":"10.3171\/jns.2001.95.5.0825","article-title":"Surgical management of brainstem cavernomas","volume":"95","author":"Samii","year":"2001"},{"key":"b43-peds13536","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1136\/jnnp.72.3.351","article-title":"Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results","volume":"72","author":"Sandalcioglu","year":"2002"},{"key":"b44-peds13536","series-title":"Pediatr Neurosurg","first-page":"281","article-title":"Brain stem cavernous angiomas in children","volume":"16","author":"Scott","year":"1991"},{"key":"b45-peds13536","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"38","DOI":"10.3171\/jns.1992.76.1.0038","article-title":"Cavernous angiomas of the central nervous system in children","volume":"76","author":"Scott","year":"1992"},{"key":"b46-peds13536","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1016\/j.jocn.2011.01.033","article-title":"Clinical features and microsurgical treatment of pediatric patients with cerebral cavernous malformation","volume":"18","author":"Song","year":"2011"},{"key":"b47-peds13536","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/00006123-200002000-00003","article-title":"Microsurgical resection of brainstem, thalamic, and basal ganglia angiographically occult vascular malformations","volume":"46","author":"Steinberg","year":"2000"},{"key":"b48-peds13536","series-title":"Epilepsy Res","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.eplepsyres.2012.08.007","article-title":"Etiology-specific differences in motor function after hemispherectomy","volume":"103","author":"van der Kolk","year":"2013"},{"key":"b49-peds13536","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1016\/S0090-3019(03)00187-3","article-title":"Surgical management of brain-stem cavernous malformations: report of 137 cases","volume":"59","author":"Wang","year":"2003"},{"key":"b50-peds13536","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3171\/jns.1991.75.1.0032","article-title":"Cavernous malformations of the brain stem","volume":"75","author":"Zimmerman","year":"1991"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/13\/5\/article-p484.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/13\/5\/article-p484.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/13\/5\/article-p484.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T14:16:07Z","timestamp":1681568167000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/13\/5\/article-p484.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,5]]},"references-count":50,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2014.2.peds13536","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,5]]}}}