Surgical management of brainstem mass lesions: Respiratory insufficiency occurrence and recovery

Surgical resection of the mass lesion arising in the brainstem, especially gliomas in the medulla oblongata, may incur the compromise of respiratory function and airway protection postoperatively. Adequate prevention and proper management of these complications is still very challenging. This article evaluates the surgical experience in 70 patients with mass lesions within the medulla oblongata and in 4 patients with mass lesions in the pons. Respiratory function and lower cranial nerve deficits are reviewed preoperatively, intraoperatively, and postoperatively in 70 patients with medulla oblongata mass lesions and in 4 patients with pons lesions. Tumor locations included the medulla oblongata (38 patients), pontomedullary region (14 patients), cervicomedullary region (18 patients), and the pons (4 patients). The pathologic results showed astrocytoma (21 patients), ependymoma (18 patients), cavernoma (18 patients), hemangioblastoma (14 patients), ganglioglioma (1 patient), tuberculoma (1 patient), and squamous cell carcinoma (1 patient). Sixty percent of patients presented with slight or mild lower cranial nerve deficit preoperatively. Most of them experienced transient exacerbation after surgery. Some patients (35.7%) required a feeding tube and tracheotomy within 48 hours to 72 hours. Swallowing studies showed 84% of patients can eliminate the feeding tube over 2 months to 6 months. Two patients still required the feeding tubes nine months and eleven months postoperatively and are still in follow-up. Other patients (14.3%) needed intermittent mechanical ventilation support for at least 2 weeks; 1 patient died of respiratory failure and pneumonia on the 64th day postoperatively. One patient required ventilator support for one hundred twenty-one days and still experienced intermittent hypoventilation after discontinuing the ventilator. Hemidiaphragmatic paralysis was noted in 2.86% of medulla oblongata cases. Lower cranial nerve deficits are the most common clinical manifestations in patients with lesions of the medulla oblongata. Temporary worsening of these problems was noted in most cases after surgery. With cystic or wellcircumscribed lesions arising in the medulla oblongata, there were no permanent respiratory problems postoperatively. Severe respiratory problems and swallowing difficulty occurred following surgery in patients with solid or diffuse astrocytoma in the medulla oblongata.