Cavernous malformations: results of image-guided resection.

With increased use of magnetic resonance imaging (MRI), diagnosis of cavernous malformations (CMs) has become straightforward. Surgical excision is the treatment of choice for these lesions. These malformations, though, are often small and can be difficult to localize during surgery. In these cases, stereotactic resection with a frame-based system is recommended to aid in localization of the malformation. However, use of these frame-based systems can be time consuming for the surgeon and onerous for the patient. With the advent of frameless stereotactic systems, these problems can be circumvented. Therefore, stereotactic resection of 17 CMs was performed for 15 patients over the course of 2 years at our institution during an investigative trial of a frameless stereotactic device. Eight patients presented with seizures, five patients with hemorrhage, and two patients with progressive headaches. Twelve of fifteen patients had normal neurological examination results on presentation, whereas three patients had deficits resulting from intracranial hemorrhages. All patients underwent diagnostic MRI preoperatively. Fourteen lesions were found to be cortical and subcortical; the other three lesions were in the basal ganglia, lateral ventricle, and pons. Following resection, 11 of 15 patients improved. Two patients developed postoperative deficits shortly after resection. One patient with a preoperative neurological deficit remained unchanged, and one patient had a recurrence of a deficit several months following resection. Image-guided stereotactic resection provides for easy localization of small malformations without requiring the use of a stereotactic frame or retractor and is well suited for resection of cavernous malformations.