Fully endoscopic approach for resection of brainstem cavernous malformations: a systematic review of the literature

Abstract Brainstem cavernous malformations (BCMs) as a benign lesion, usually has an acute onset and leads to a high rate of morbidity. According to the different anatomical sites of various brainstem lesions, the selection of the optimal surgical approach is the premise of obtaining favorable surgical outcomes. Due to the depth illumination and panoramic view of endoscope compared with microscope, endoscopic surgery is gradually applied in the treatment of BCMs. For intra-axial ventral BCMs, the best surgical options are endoscopic endonasal approaches according to the “two-point method. For cavernous hemangiomas on the dorsal of the brainstem, the value of endoscopy lies in the better visualization of the operative field provided by the endoscope and the minimization of brain retraction. In this review, we gathered data on the fully endoscopic approach for resection of BCMs, and outline technical notes and tips for this approach. Seventeen cases from a total of 14 articles were included in the present review. The endoscopic endonasal approach was applied in 14 patients, endoscopic transcranial approach was performed in 3 patients. The total resection rate of lesions was 76.5% (14/17). In the 14 cases of endoscopic endonasal surgery, postoperative CSF leakage was found in 4 cases. The maximum diameter of lesion in 3 patients with postoperative CSF rhinorrhea was greater than 2cm. In the 15 patients with follow-up data, 2 patients showed no significant improvement after surgery, the remaining 13 patients showed significant improvement compared with admission. This systematic review of the literature demonstrates that a fully endoscopic approach to the BCMs is a safe and effective option for resection, which can be considered as an alternative to conventional craniotomy for dealing with these challenging lesions by a team of neurosurgeons with extensive experience in endoscopic surgery.