Surgical strategy and outcome of supratentorial cavernous hemangiomas

Introduction: Cavernous angiomas of the brain are vascular malformations diagnosed mainly by intracerebral hemorrhages, neurological dysfunction and seizures. The introduction of MR imaging has resulted in a marked increase in the number of cavernomas diagnosed. Generally small and well defined lesions, cavernous angiomas usually can be totally resected microsurgically, but their safe localisation is important to minimize traumatization of adjacent brain tissue. We report our experience with the resection of supratentorial cavernomas against the backdrop of the development from framebased to frameless stereotactic localization. Methods: In a period of fifteen years (1.1.1981-30.10.1996), 77 cavernoma resections were performed at our hospital, 53 of them were located supratentorially. The mean patient age was 35 years (range 8-74 years); 33 of them were males and 20 females. Surgical guidance was used in 34 of 53 supratentorial cavenoma resections. In 19 cases operated between 1.1.1981 and 30.10.1996, stereotactic framebased localization was chosen. After neuronavigation- systems had become available in April 1995, frameless stereotactic localization of 12 supratentorial cavernomas was performed using these systems. Results: Successful planning of the stereotactic craniotomy and of the surgical approach was possible using the framebased stereotactic systems. In the frameless navigated surgeries, a high degree of accuracy with a deviation of less than 4 mm was obtained, all cavernomas were targeted successfully. Discussion: Especially in eloquent areas the location of cavernous haemangiomas is important for successful surgical resection. But also in lesions which are located on the surface of the brain the frameless neuronavigation keeps the skin incision and craniotomy as small as necessary and helps to perform a minimal invasive surgery.