{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:27:52Z","timestamp":1788992872869,"version":"build-2803163510"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Brainstem cavernous malformations (BSCMs) were once considered inoperable. Microsurgical resection now represents a valuable option for treating patients with hemorrhagic or symptomatic lesions. The aim of this study was to provide a practical guide for surgical planning by analyzing postoperative neurological and functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The early- and long-term neurological (National Institutes of Health Stroke Scale [NIHSS] score) and functional (modified Rankin Scale [mRS] and Glasgow Outcome Scale [GOS] scores) outcomes of 32 patients who underwent surgery for hemorrhagic BSCM were reviewed. The three-step surgical planning was based on an anatomosurgical algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Nine lesions (28.1%) were located in the mesencephalon, 19 (59.4%) in the pons, and 4 (12.5%) in the medulla. A fronto-temporo-orbito-zygomatic approach was selected to reach anterior mesencephalic BSCMs (2, 6.3%). A retrosigmoid approach and its extended variant were selected for lateral mesencephalic (6, 18.8%), anterior (2, 6.3%) and lateral (13, 40.6%) pontine, and anterior (1, 3.1%) and lateral (1, 3.1%) medullary BSCMs. A supracerebellar infratentorial approach was selected for posterior mesencephalic BSCMs (1, 3.1%). A telovelar approach was selected for posterior pontine (4, 12.5%) and medullary (2, 6.3%) BSCMs. Total resection was achieved in 29 cases (90.6%), with a 12.5% rate of surgical complications. The NIHSS score progressively improved at both the early (5.16 \u00b1 3.70 vs 4.63 \u00b1 2.78, p = 0.446) and late (4.63 \u00b1 2.78 vs 2.41 \u00b1 2.39, p &lt; 0.001) postoperative evaluations. Functional outcomes showed an initial deterioration followed by a long-term improvement (mRS score: 2.66 \u00b1 1.07 vs 3.06 \u00b1 1.11 vs 2.13 \u00b1 1.29, GOS score: 3.78 \u00b1 0.61 vs 3.59 \u00b1 0.62 vs 4.19 \u00b1 0.78). Time to surgery significantly correlated with early- and long-term NIHSS, mRS, and GOS scores, while the number of hemorrhages before surgery correlated with early- and long-term mRS and GOS scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Early surgery after the first bleed following systematic surgical planning may be considered as an effective option for managing hemorrhagic BSCMs with acceptable operative morbidity and relatively favorable early- and long-term neurological and functional outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.8.jns241171","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T20:25:43Z","timestamp":1735935943000},"page":"1465-1475","source":"Crossref","is-referenced-by-count":5,"title":["Neurological and functional outcomes of 32 patients with hemorrhagic brainstem cavernous malformations: a practical guide for surgical planning"],"prefix":"10.3171","volume":"142","author":[{"given":"Carmine A.","family":"Donofrio","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, ASST Cremona, Italy;"},{"name":"Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenan","family":"Arnautovic","sequence":"additional","affiliation":[{"name":"Semmes Murphey Clinic and Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Riccio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, ASST Cremona, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Badaloni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Roncaroli","sequence":"additional","affiliation":[{"name":"Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Servadei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Humanitas Clinical and Research Center\u2013IRCCS, Rozzano, Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Surgery, Tulane University School of Medicine, New Orleans, Louisiana;"},{"name":"Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana;"},{"name":"Department of Anatomical Sciences, Saint George\u2019s University, Saint George\u2019s, Grenada;"},{"name":"Department of Anatomical Sciences, University of Queensland, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Fioravanti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, ASST Cremona, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Neurosurg","first-page":"50","article-title":"Cavernous malformations of the brainstem: experience with 100 patients","volume":"90","author":"Porter RW","year":"1999","unstructured":"Porter RW, Detwiler PW, Spetzler RF,  Cavernous malformations of the brainstem: experience with 100 patients. 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