Functional outcome after pediatric cerebral cavernous malformation surgery

Abstract

The purpose of this study was to investigate the functional outcome following surgical resection of cerebral cavernous malformations (CCM) in pediatric patients. We screened our institutional database of CCM patients treated between 2003 and 2021. Inclusion regarded individuals younger or equal than 18 years of age with complete clinical baseline characteristics, magnetic resonance imaging dataset, and postoperative follow-up time of at least three months. Functional outcome was quantified using the modified Rankin Scale (mRS) score and assessed at admission, discharge, and last follow-up examination. The primary endpoint was the postoperative functional outcome. As a secondary endpoint, predictors of postoperative functional deterioration were assessed. A total of 49 pediatric patients with a mean age of 11.3 ± 5.7 years were included for subsequent analyses. Twenty individuals (40.8%) were female. Complete resection of the lesion was achieved in 44 patients (89.8%), and two patients with incomplete resection were referred for successive remnant removal. The mean follow-up time after surgery was 44 months (IQR: 13 – 131). The mean mRS score was 1.6 on admission, 1.7 at discharge, and 0.9 at the latest follow-up. Logistic regression analysis adjusted to age and sex identified brainstem localization (aOR = 53.45 [95%CI = 2.26 − 1261.81], p = .014) as a predictor of postoperative deterioration. This study indicates that CCM removal in children can be regarded as safe and favorable for the majority of patients, depending on lesion localization. Brainstem localization implies a high risk of postoperative morbidity and indication for surgery should be balanced carefully. Minor evidence indicates that second-look surgery for CCM remnants might be safe and favorable.

Focused Ultrasound Blood-Brain Barrier Opening Arrests the Growth and Formation of Cerebral Cavernous Malformations

“…The only curative treatment option for these patients currently is resection of symptomatic CCMs via invasive neurosurgery, which is associated with a high risk of postoperative morbidities. Further, some CCMs are not surgically accessible 6,35,36 . While SRS may be deployed for patients with inaccessible lesions, SRS can present adverse radiation side effects, induce new CCMs in certain patient populations, and may have limited therapeutic efficacy 37–48 .…”

A rare case of cavernous malformation of the cauda equina a case report

“…The management of spinal cord CM may be surgical or conservative, pending various factors [ 9 ]. The latter is especially considered in the event of an incidental finding or asymptomatic patient.…”

Outcomes after surgical and nonsurgical treatment of pediatric cerebral cavernous malformation

“…Most children showed excellent seizure control after surgery, which was comparable with previous reports. 6 , 26 Only two patients with multiple CCM in the frontal and temporal lobe still had persistent seizure symptoms after surgery (ILAE class 4).…”