{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T09:37:09Z","timestamp":1780652229099,"version":"3.54.1"},"reference-count":52,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T00:00:00Z","timestamp":1693872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Cavernous malformations (CM) are vascular malformations with low blood flow. The removal of brainstem CMs (BS) is associated with high surgical morbidity, and there is no general consensus on when to treat deep-seated BS CMs. The aim of this study is to compare the surgical outcomes of a series of deep-seated BS CMs with the surgical outcomes of a series of superficially located BS CMs operated on at the Department of Neurosurgery, College of Tuebingen, Germany. Materials and Methods: A retrospective evaluation was performed using patient charts, surgical video recordings, and outpatient examinations. Factors were identified in which surgical intervention was performed in cases of BS CMs. Preoperative radiological examinations included MRI and diffusion tensor imaging (DTI). For deep-seated BS CMs, a voxel-based 3D neuronavigation system and electrophysiological mapping of the brainstem surface were used. Results: A total of 34 consecutive patients with primary superficial (n = 20\/58.8%) and deep-seated (n = 14\/41.2%) brainstem cavernomas (BS CM) were enrolled in this comparative study. Complete removal was achieved in 31 patients (91.2%). Deep-seated BS CMs: The mean diameter was 14.7 mm (range: 8.3 to 27.7 mm). All but one of these lesions were completely removed. The median follow-up time was 5.8 years. Two patients (5.9%) developed new neurologic deficits after surgery. Superficial BS CMs: The median diameter was 14.9 mm (range: 7.2 to 27.3 mm). All but two of the superficial BS CMs could be completely removed. New permanent neurologic deficits were observed in two patients (5.9%) after surgery. The median follow-up time in this group was 3.6 years. Conclusions: The treatment of BS CMs remains complex. However, the results of this study demonstrate that with less invasive posterior fossa approaches, brainstem mapping, and neuronavigation combined with the use of a blunt \u201cspinal cord\u201d dissection technique, deep-seated BS CMs can be completely removed in selected cases, with good functional outcomes comparable to those of superficial BS CM.<\/jats:p>","DOI":"10.3390\/medicina59091601","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T09:46:20Z","timestamp":1693907180000},"page":"1601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Brainstem Cavernoma Case Series: A Formula for Surgery and Surgical Technique"],"prefix":"10.3390","volume":"59","author":[{"given":"Marcos","family":"Tatagiba","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9030-4192","authenticated-orcid":false,"given":"Guilherme","family":"Lepski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Kullmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Krischek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soeren","family":"Danz","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Bornemann","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Klein","sequence":"additional","affiliation":[{"name":"Institute for Medical Image Computing, Fraunhofer MEVIS, 28359 Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Fahrig","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiooncology, General Hospital Klinikum Bamberg, 96049 Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-4348","authenticated-orcid":false,"given":"Tomaz","family":"Velnar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guenther C.","family":"Feigl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tuebingen Medical Center, 72074 T\u00fcbingen, Germany"},{"name":"Department of Neurosurgery, General Hospital Klinikum Bamberg, 96049 Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2010.5.FOCUS10149","article-title":"Update on the natural history of cavernous malformations and factors predicting aggressive clinical presentation","volume":"29","author":"Washington","year":"2010","journal-title":"Neurosurg. 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