INC Professor answers questions about brainstem cavernous hemangioma

INC Professor answers questions about brainstem cavernous hemangioma.   Can brainstem cavernous hemangioma be operated? What are the risks of surgery?

Brainstem cavernous hemangioma (CMs) accounts for about 20% of all central nervous system CMs, mainly in the pons. The symptoms are more typical because of the location of the lesion and the surrounding structures. Due to the complex and important anatomy of the brainstem and the surrounding important nerve and blood vessel structures, there may be a risk of damaging important functional structures when microresection of CMs. When considering whether to operate, this question requires a decision-making process. Before surgical treatment, it is necessary to balance the natural history of the disease, the benefits of surgery, the risk of future bleeding, and the relief of current symptoms. Professor Bart Langfei, a member of the World Neurosurgery Advisory Group (WANG), a member of the INC International Neurosurgery Group, answered the hot issues of brainstem cavernous hemangioma that patients are concerned about.

Q: Can brainstem cavernous hemangioma be operated? What are the risks of surgery? What is the surgical resection rate for this disease?

INC Professor Bart Langfei: Yes, the cavernous hemangioma of the brain stem can be operated. Although the brainstem is located in a very critical area, it is a very critical part of our brain. It is important for many functions, such as vision, movement, swallowing and other functions. The nerve tissue is so tight in the brainstem, even if it is Within a very small range. Even with only 3, 4, or 5 mm injuries, it can already bring some clinical symptoms, such as neurological deficits.

Therefore, we should also say that cavernous hemangioma with accompanying bleeding already has a high risk, because bleeding can be repeated, sometimes it can be repeated a second or three times, and it may be worse every time. In the past 20 years, I have specialized in treating various types of brainstem cavernous hemangioma. I can say that I know a lot about these lesions, but I can still learn new knowledge from my patients, even now, because every case is different. In many aspects, when we talk about surgical treatment, we hope that when we talk about surgical treatment, we know what kind of surgical approach to reach the lesion, and there are several possibilities to reach it. This requires long-term experience to make the right decision. In addition, the timing of surgery is also very important, as is the technique.

You asked me about the risks of surgery. Recurring bleeding or serious neurological problems after surgery is very likely to happen. Unlike gliomas, we can almost achieve 100% removal of brainstem cavernous hemangioma. I say that it is almost because in a few cases it is impossible to achieve 100%, because it faces a high-risk situation. No one wants to have such a high risk, so the surgeon must evaluate it during the operation, which is what I am doing. In most cases, 95% can achieve 100% tumor or cavernous hemangioma resection.

Q: If the patient experiences bleeding not long ago, can he or she be operated on? Or do I need to wait for a while before the operation?

Professor Bart Langfield, INC: I noticed that many doctors follow a concept that was quite popular 30 years ago, and more of waiting. But my philosophy is different. My experience tells me that early surgery is better for patients. The earlier the operation, the better for the patient after bleeding. Of course, this depends on the specific situation, the size of the bleeding and the patient’s neurological condition.

But waiting, as sometimes recommended by many doctors, is not good, because after long-term waiting, after the initial bleeding, a local scar will form, and the formation of this scar actually hinders a good operation. This makes surgery more difficult, more dangerous, and sometimes prevents complete removal of the lesion. Another important factor is that in the early stages of bleeding, the bleeding is still more or less a fluid. So when we open the brainstem of the bleeding area through surgery, the blood can be flushed out, which is very useful in surgery. If we wait a few weeks, the blood will clot, become more stiff and harder to clear.

Q: Under what circumstances does cavernous hemangioma in the brainstem area need to be surgically removed? At any time and under any condition?

INC. Professor Bart Langfei: No, in many cases, patients have undergone an MRI examination due to a minor accident. They may fall while riding a bicycle or doing some exercise. Then the doctor recommends an MRI examination and then an MRI examination. During this period, sometimes we can find patients with cavernous hemangioma in any part of the brain, even the brain stem. These patients may never experience any symptoms of cavernous tumors. In this case, we usually do not operate because these cavernous hemangiomas can remain bleeding-free for more than 10 or 20 years.

I know a patient with cavernous hemangioma, it has been almost 30 years now. He had a bleeding about 30 years ago, and since then, there has been no second bleeding. For this situation, we will not choose surgery. But what I would suggest for surgery is that all patients with bleeding and neurological problems or severe symptoms may have their second or third bleeding. All these patients should undergo surgery.

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