An Algorithm for the Microsurgical Resection of Cerebellar Cavernomas

BACKGROUND AND OBJECTIVES: Cavernous malformations (CMs) account for 8% to 15% of all cerebrovascular anomalies and pose clinical significance due to their potential to cause symptomatic hemorrhage, seizures, and focal neurological deficits. While the majority of CMs are located supratentorial, the less common posterior fossa, particularly cerebellar CMs (cCMs), pose a unique treatment challenge. This study aims to contribute to the understanding and management of cerebellar CMs, thereby assisting in the decision-making process for clinical interventions in this patient population. METHODS: We conducted a retrospective analysis of all patients who were treated for CMs from 2010 to 2023 at our tertiary healthcare facility. Patients with cCMs were further analyzed concerning their treatment strategy and functional outcome based on the modified Rankin Scale. RESULTS: Nine hundred fourteen patients with CMs were treated between 2013 and 2023 at our center. Among these subjects, 6.5% (n = 59) presented with cerebellar lesions. The median age was 54 [37-64] years, and 15 (25.4%) patients showed associated developmental venous anomalies. Nearly half of these patients (49.0%) were surgically treated. Surgical approaches were tailored and individualized to the specific CM location based on a treatment algorithm and encompassed supracerebellar-infratentorial, telovelar, suboccipital transcortical, retrosigmoid transcortical, and retrosigmoidal transhorizontal fissure approaches. Univariate analysis revealed no risk factors concerning postoperative morbidity. The surgically treated patients showed a significant improvement between preoperative and follow-up functional outcomes. CONCLUSION: cCMs are rare but frequently necessitate surgical intervention. This study enhances the current understanding of cCMs, underscoring the intricate challenges associated with their management. Differentiated algorithms with tailored approaches ensure the optimization of outcomes in the treatment of these challenging lesions.