Quality of Life After Surgery for Cerebral Cavernoma: Brainstem Versus Nonbrainstem Location

Cornelius, Jan Frédérick; Kürten, K.; Fischer, Igor; Hänggi, Daniel; Steiger, Hans Jakob

doi:10.1016/j.wneu.2016.08.014

Cited by 20 publications

(21 citation statements)

References 25 publications

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“…CCMs have an incidence of <1%, an annual hemorrhage risk of up to 3%, and a rebleed risk of 4.5–23% per year [12]. They are the second most common form of intravascular malformations, after DVA.…”

Section: Cerebral Cavernous Malformationsmentioning

confidence: 99%

Cerebral Cavernous Malformations, Developmental Venous Anomaly, and Its Coexistence: A Review

et al. 2020

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Background: Cerebral cavernous malformations (CCMs) are intracranial vascular malformations that can exist as a single lesion or mixed vascular lesions. The most common mixed form is the coexistence of CCM with an associated developmental venous anomaly (DVA). In this paper, we aim to give a comprehensive review of CCM, DVA, and their coexistence as mixed lesions. A PubMed search using the keywords “Cerebral cavernous malformations, Developmental venous anomaly, Mixed Cerebral cavernous malformations with Developmental venous anomaly” was done. All studies in the English language in the past 10 years were analyzed descriptively for this review. Summary: The search yielded 1,249 results for “Cerebral cavernous malformations,” 271 results for “Developmental venous anomaly,” and 5 results for “Mixed Cerebral cavernous malformations with Developmental venous anomaly.” DVA is the most common intracranial vascular malformation, followed by CCM. CCM can have a wide array of clinical presentations like hemorrhage, seizures, or focal neurological deficits or can also be an incidental finding on brain imaging. DVAs are benign lesions by nature; however, venous infarction can occur in a few patients due to acute thrombosis. Mixed CCM with DVA has a higher risk of hemorrhage. CCMs are angiographically occult lesion, and cerebral digital subtraction angiography is the gold standard for the diagnosis of DVA. Mixed lesions, on the other hand, are best diagnosed with magnetic resonance imaging, which has also been effective in detecting specific abnormalities. Asymptomatic lesions are treated through a conservative approach, while clinically symptomatic lesions need surgical management. Conclusion: Individual CCM or DVA lesions have a benign course; however, when they coexist in the same individual, the hemorrhagic risk is increased, which prompts for rapid diagnosis and treatment.

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Section: Cerebral Cavernous Malformationsmentioning

confidence: 99%

Cerebral Cavernous Malformations, Developmental Venous Anomaly, and Its Coexistence: A Review

et al. 2020

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“…Few studies evaluating HRQOL in CCM exist so far: Cornelius et al . [19] and Dukatz et al . [20] evaluated HRQOL in patients who underwent surgery of brainstem or non‐brainstem CCMs.…”

Section: Discussionmentioning

confidence: 99%

“…However, whilst reporting standards [16] and all larger previous series mainly focus on occurrence/rate of SH and functional impairment, the important clinical parameter health‐related quality of life (HRQOL) to estimate the burden of a disease has been nearly completely neglected in patients with CCM. Only few series [12,17–20], especially on postoperative HRQOL [12,19,20], exist.…”

Section: Introductionmentioning

confidence: 99%

Health‐related quality of life in patients with untreated cavernous malformations of the central nervous system

Herten

Saban

et al. 2020

Euro J of Neurology

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Background and purposeTo estimate health‐related quality of life (HRQOL) in patients with untreated cavernous malformation of the CNS [cavernous cerebral malformations (CCMs)].MethodsWe performed a cross‐sectional observational study on patients with CCMs admitted to our department from 1 November 2017 to 10 January 2020 using standardized interviews [short‐form‐36 questionnaire, hospital anxiety and depression score (HADS‐A/D), CCM perception questionnaire]. Included criteria were diagnosis of an untreated CCM and information about the diagnosis in a specialized CCM consultation. Health‐related quality of life (HRQOL) data were analyzed and compared to the German normal population. Uni‐ and multivariate analyses were carried out to identify variables with impact on outcome.ResultsTwo hundred nineteen (93%) of 229 eligible patients were included. Mean age was 46.3 ± 14.7 (18–86) years; 136 (62%) were female. Ninety‐eight (45%) patients presented with symptomatic hemorrhage (SH), and 17 (8%) with repetitive SH. Ninety‐two (42%) patients were asymptomatic. Thirty‐seven patients (17%) suffered from cavernoma‐related epilepsy. Twenty‐eight patients (13%) suffered from familial CCMs. Patients showed significantly decreased component scores and subdomain scores compared to the normal population, with effects ranging from small to large. This accounted largely also for asymptomatic patients (except for physical component score and main physical subdomains). Multivariate regression analysis confirmed impact of functional impairment on physical component score. HADS‐A was significantly increased. HADS‐A/D strongly correlated with mental component score and individual perception of the CCM.ConclusionsPatients with the diagnosis of a CCM showed decreased HRQOL compared to the normal population even when not suffering functional impairment or neurological symptoms. Our data may function as benchmarks in evaluation of different (future) management strategies.

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“…We identified only two studies of quality of life (QoL) for people with CCM (both after intervention). 12,13 Therefore, we designed a survey using SurveyMonkey (www.surveymonkey.co.uk) and asked the Cavernoma Alliance UK (CAUK; www.cavernoma.org.uk) patient support organization to contact patient members on 30 November 2016. The survey contained structured questions to characterize their CCM, clinical history, and QoL using the five-level EQ-5D version of the EuroQol.…”

Section: Survey Of Qol Among Patients With Ccmmentioning

confidence: 99%

Radiosurgical, neurosurgical, or no intervention for cerebral cavernous malformations: A decision analysis

Rinkel

Salman

Rinkel

et al. 2019

International Journal of Stroke

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Introduction We aimed to evaluate the preferred treatment strategy for patients with symptomatic cerebral cavernous malformations (CCM). Methods In a decision model, we compared neurosurgical, radiosurgical, and conservative management. A literature review yielded the risks and outcomes of interventions, intracerebral hemorrhage (ICH), and seizures. Patients with CCM rated their quality of life to determine utilities. We estimated the expected number of quality-adjusted life years (QALYs) and the ICH recurrence risk over five years, according to mode of presentation and CCM location (brainstem vs. other). We performed analyses with a time horizon of five years. Results Using the best available data, the expected number of QALYs for brainstem CCM presenting with ICH or focal neurological deficit was 2.84 (95% confidence interval [CI]: 2.54–3.08) for conservative, 3.01 (95% CI: 2.86–3.16) for neurosurgical, and 3.03 (95% CI: 2.88–3.18) for radiosurgical intervention; those for non-brainstem CCM presenting with ICH or focal neurological deficit were 3.08 (95% CI: 2.85–3.31) for conservative, 3.21 (95% CI: 3.01–3.36) for neurosurgical, and 3.19 (95% CI: 2.98–3.37) for radiosurgical intervention. For CCM presenting with epilepsy, QALYs were 3.09 (95% CI: 3.03–3.16) for conservative, 3.33 (95% CI: 3.31–3.34) for neurosurgical, and 3.27 (95% CI: 3.24–3.30) for radiosurgical intervention. Discussion and conclusion For the initial five years after presentation, our study provides Class III evidence that for CCM presenting with ICH or focal neurological deficit conservative management is the first option, and for CCM presenting with epilepsy CCM intervention should be considered. More comparative studies with long-term follow-up are needed.

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Quality of Life After Surgery for Cerebral Cavernoma: Brainstem Versus Nonbrainstem Location

Cited by 20 publications

References 25 publications

Cerebral Cavernous Malformations, Developmental Venous Anomaly, and Its Coexistence: A Review

Cerebral Cavernous Malformations, Developmental Venous Anomaly, and Its Coexistence: A Review

Health‐related quality of life in patients with untreated cavernous malformations of the central nervous system

Radiosurgical, neurosurgical, or no intervention for cerebral cavernous malformations: A decision analysis

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