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Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature

  • Clinical Article - Vascular
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Abstract

Background

We describe 11 patients with hypertrophic olivary degeneration (HOD) after surgical resection or gamma knife radiosurgery for brainstem cavernous malformations. In addition, we statistically analyzed the predicting factors associated with the development of HOD.

Methods

From January 2001 to May 2011, a total of 73 patients (30 in the surgical group and 43 in the radiosurgery group) with brainstem cavernous malformations were treated in our institute. Of them, 11 patients (incidence: 15 %) developed HOD with high signal intensity on T2-weighted MRI during follow-up. The predicting factors (location, size, age, and treatment method) associated with the development of HOD were statistically analyzed.

Results

Among the 11 HOD patients, seven patients received surgical resection and four patients received gamma knife radiosurgery. Six patients had bilateral HOD and the remaining five patients had unilateral HOD. Overall HOD-associated symptoms presented in four patients, including three palatal tremors and one ataxia. In all four patients with symptoms, these symptoms disappeared incompletely within the clinical follow-up period. The size of the cavernous malformation, age of patient, and treatment methods were not significantly correlated with the development of HOD. A significantly higher incidence of HOD was associated with midbrain cavernous malformations than with pontine or medulla cavernous malformations.

Conclusions

HOD should be recognized as a non-infrequent complication of surgical resection or gamma knife radiosurgery within the brainstem, especially for midbrain cavernous malformations. In addition, to the best of our knowledge, this is the first report on HOD development after radiosurgery.

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Authors and Affiliations

  1. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2 dong, Songpa-gu, Seoul, 138-736, South Korea

    Jung-Ho Yun, Jae Sung Ahn, Jung Cheol Park, Do Hoon Kwon, Byung Duk Kwun & Chang Jin Kim

Authors
  1. Jung-Ho Yun
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  2. Jae Sung Ahn
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  3. Jung Cheol Park
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  4. Do Hoon Kwon
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  5. Byung Duk Kwun
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  6. Chang Jin Kim
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Corresponding author

Correspondence to Jae Sung Ahn.

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Comment

This is a very interesting article. Brain stem lesions have been considered untouchable by many for a long time, but with advances in microsurgery and the development of less invasive radiosurgical tools, there is an increased willingness to enter this region and treat/operate upon different pathologies. Given the relatively benign course of cavernomas, post-surgical or radiosurgical effects are observable and their course possible to follow. It is of note that whichever is the intervention, the likelihood of development of hypertrophic olivary degeneration is the same, and it is reassuring to note that the changes are not always permanent.

Andras Kemeny

Sheffield, UK

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Yun, JH., Ahn, J.S., Park, J.C. et al. Hypertrophic olivary degeneration following surgical resection or gamma knife radiosurgery of brainstem cavernous malformations: an 11-case series and a review of literature. Acta Neurochir 155, 469–476 (2013). https://doi.org/10.1007/s00701-012-1567-y

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  • DOI: https://doi.org/10.1007/s00701-012-1567-y

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