Overview of cerebral cavernous malformations: comparison of treatment approaches

Abstract

ObjectivesThe comparison of treatment efficacy for cerebral cavernous malformations (CCMs) has not yet been well researched.DesignPubMed, Cochrane Library, Science Direct, ISI Web of Science, Embase and additional sources were searched to identify cohort studies about the treatment of CCMs published between 1990 and 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; the Newcastle-Ottawa Scale was used to assess the risk of bias and to evaluate limitations based on selection/outcome biases. The cumulative incidences with 95% CIs were calculated using the random effects model. The models of Poisson distribution were applied to evaluate risk factors of poorer treatment outcome by calculating rate ratios within 100 person-years with 95% CIs.ResultsA total of 100 cohorts yielding 8994 patients treated for CCMs within 41 098 person-years of follow-up were analysed. The efficacy of ensuring the prevention of haemorrhage was 97% in surgical, 86% in radiosurgical and 77% in the conservative treatment. The lowest mortality (1%) was after radiosurgery, and the highest persistent morbidity (22%) was in natural history series. Deep-seated and brainstem CCMs were associated with higher bleeding rates. Lobar localisation was a protective factor in all analyses. Patients with history of previous haemorrhage were exposed to higher risk of rebleeding. Male gender was a protective factor associated with lower risk of post-treatment haemorrhage.ConclusionsSurgical resection of CCM is effective in ensuring the prevention of haemorrhage with acceptable morbidity and mortality, but conservative and radiosurgical management is a justified treatment alternative. Brainstem and deep-seated CCMs are predominantly associated with higher haemorrhage rates.

Central nervous system cavernous malformations: cross‐sectional study assessing rebleeding risk after a second haemorrhage

“…According to the most recent and largest meta-analysis from 2022, Bubenikova et al were able to assess and compare treatment approaches in 8994 patients suffering from a CCM. They found a higher prevention of (re)haemorrhage in patients undergoing surgical removal of their lesion, as well as additionally lower rates of morbidity compared to conservatively treated patients [26]. Their findings as well as further confirmation of our data could possibly affect treatment guidelines, leading to a more aggressive treatment after recurrent CM bleeding.…”

“…Unfortunately, such studies are often limited to the assessment of initial and recurrent bleeding and the risk of a third bleeding has yet to be discovered [1,4,5,7,8,10,18,20]. Moreover, a significant number of trials analysing the outcome after treatments of such lesions exist [1,4,10,[24][25][26]. However, only a paucity of studies have tried to address the neurological impact of recurrent haemorrhagic events [4,9,14].…”

Possible association between minor head injury and intratumoral hemorrhage: A metastatic brain tumor from thyroid carcinoma

“…Cerebral cavernous malformations (CCMs) are hamartomatous vascular malformations characterized by intralesional hemorrhages [9 , 10] . The mean annual hemorrhage rate of CCMs is approximately 2.4% [11] .…”

A feasibility study for quantitative assessment of cerebrovascular malformations using flutriciclamide ([18F]GE-180) PET/MRI

“…Approximately 75% of patients with these cerebrovascular malformations have a high risk of intracranial hemorrhages, seizures, focal neurological deficits, and severe headaches secondary to CCM ( 5 ). Currently, surgery or radiosurgery of are possible interventional treatment options for patients with symptomatic CCM ( 6 ). Although genetic mutations in KRIT1/CCM1 , CCM2 , and PDCD10/CCM3 are known causes of CCM ( 7 ), factors influencing rates of disease severity and progression of CCM remain unknown.…”