Risk Factors for Unfavorable Outcomes in Surgically Treated Brainstem Cavernous Malformations

Nathal, Edgar; Patiño-Rodríguez, Hernán Mauricio; Araúz, Antonio; Imam, Sayem S; Acosta, Edgar; Evins, Alexander I.; Longo, Gabriel Mauricio

doi:10.1016/j.wneu.2017.12.105

Cited by 21 publications

(4 citation statements)

References 15 publications

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“…Based on the variables within the BSCM grading scale and relevant risk factors that have been previously discussed in previous literature recognized to impact postoperative outcomes in BSCMs, we integrated the following variables: sex, age, mRS score on hospital admission, preoperative multiple bleedings, hemorrhage-to-treatment time, ventilator dependence, motor deficit, hemiparesthesia, and deep located lesion (Table S1). 1,14,15,[17][18][19][20][21] Data pertaining to these variables were extracted from electronic medical records. Furthermore, we compiled radiographic variables to describe the morphological characteristics of BSCMs, encompassing, including location, size, depth, perilesional edema, DVA, crossing axial midpoint, deep location, and Zabramski classification.…”

Section: Data Collection and Variable Selectionmentioning

confidence: 99%

“…These factors extend beyond the scope of the prior scales and include variables such as the modified Rankin Scale (mRS) score on admission, preoperative multiple bleedings, deep location, perilesional edema, and motor deficit. [13][14][15] Additionally, as research on the effectiveness of radiosurgery treatment for BSCMs continues to advance, there is a growing demand for a concise and academically rigorous surgical grading system to weigh treatment options.…”

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confidence: 99%

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Development and Validation of a Supplementary Grading Scale for Outcomes of Brainstem Cavernous Malformations

Li,

Lu,

Liu

et al. 2024

Stroke

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BACKGROUND: Surgical risk assessment is intriguing for clinical decision-making of brainstem cavernous malformation (BSCM) treatment. While the BSCM grading scale, encompassing size, developmental venous anomaly, crossing axial midpoint, age, and timing of intervention, is increasingly utilized, the clinical relevance of neurological fluctuation and recurrent hemorrhage has not been incorporated. This study aimed to propose a supplementary grading scale with enhanced predictive efficacy. METHODS: Using a retrospective nationwide registry of consecutive patients with BSCMs undergoing surgery in China from March 2011 to May 2023, a new supplementary BSCM grading scale was developed from a derivative cohort of 260 patients and validated in an independent concurrent cohort of 67 patients. The primary outcome was unfavorable neurological function (modified Rankin Scale score >2) at the latest follow-up. The performance of the supplementary grading system was evaluated for discrimination, calibration, and clinical utility and further compared with its original counterpart. RESULTS: Over a follow-up of at least 6 months after surgery, the unfavorable outcomes were 31% in the overall cohort (101/327 patients). A preoperative motor deficit (odds ratio, 3.13; P =0.001), recurrent hemorrhage (odds ratio, 3.05; P <0.001), timing of intervention (odds ratio, 7.08; P <0.001), and crossing the axial midpoint (odds ratio, 2.57; P =0.006) were associated with the unfavorable outcomes and composed the initial Huashan grading variables. A supplementary BSCM grading system was subsequently developed by incorporating the Huashan grading variables into the original BSCM grading scale. The predictive capability of the supplementary scale was consistently superior to the original counterpart in either the derivative cohort (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.68–0.80] for the supplementary versus 0.68 [95% CI, 0.61–0.74] for the original) or the validation cohort (0.75 [95% CI, 0.62–0.87] versus 0.64 [95% CI, 0.48–0.81]). CONCLUSIONS: This study highlights the neurological relevance of BSCM hemorrhage in surgical risk assessment. Via compositing preoperative motor function and recurrent hemorrhages, a supplementary grading scale may improve a dynamic risk assessment for clinical decisions in the management of BSCMs.

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Section: Data Collection and Variable Selectionmentioning

confidence: 99%

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confidence: 99%

Development and Validation of a Supplementary Grading Scale for Outcomes of Brainstem Cavernous Malformations

Li,

Lu,

Liu

et al. 2024

Stroke

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“…Brainstem cavernous malformations (BSCM) are lowflow vascular lesions that can result in significant neurological morbidity [1]. Mortality rates following surgery range from 0 to 1.9% in the literature, whereas mortality rates of up to 20% have been reported for patients managed conservatively [1,2].While the 1st BSCM hemorrhage is often benign, repeat BSCM hemorrhages, which have been reported in up to 60% of patients, often create a progressive pattern of neurological decline, with most patients never returning to their pre-hemorrhage baseline [3][4][5]. Risk assessment with regard to morbidity and This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) (http://www.karger.com/Services/ OpenAccessLicense).…”

Section: Introductionmentioning

confidence: 99%

Mortality in Patients with Brainstem Cavernous Malformations

et al. 2021

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Objective: Brainstem cavernous malformations (BSCM)-associated mortality has been reported up to 20% in patients managed conservatively, whereas postoperative mortality rates range from 0 to 1.9%. Our aim was to analyze the actual risk and causes of BSCM-associated mortality in patients managed conservatively and surgically based on our own patient cohort and a systematic literature review. Methods: Observational, retrospective single-center study encompassing all patients with BSCM that presented to our institution between 2006 and 2018. In addition, a systematic review was performed on all studies encompassing patients with BSCM managed conservatively and surgically. Results: Of 118 patients, 54 were treated conservatively (961.0 person years follow-up in total). No BSCM-associated mortality was observed in our conservatively as well as surgically managed patient cohort. Our systematic literature review and analysis revealed an overall BSCM-associated mortality rate of 2.3% (95% CI: 1.6–3.3) in 22 studies comprising 1,251 patients managed conservatively and of 1.3% (95% CI: 0.9–1.7) in 99 studies comprising 3,275 patients with BSCM treated surgically. Conclusion: The BSCM-associated mortality rate in patients managed conservatively is almost as low as in patients treated surgically and much lower than in frequently cited reports, most probably due to the good selection nowadays in regard to surgery.

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“…Now that our patient is in good conditions, we can analyze the surgical approach since the hematoma is still in the subacute phase (Nathal et al, 2018). Now, if we analyze the axial cut of the MRI, where the cavernous malformation is sitting, and we remember the neural tracts and nuclei of the mesencephalon (Giliberto et al, 2010).…”

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confidence: 99%

Subtemporal approach for the resection of a midbrain cavernous malformation: evaluation of safe surgical corridors

Correa¹,

Ceja²,

Mendez-Rosito³

2019

Neurosurgical Focus: Video

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Brainstem cavernous malformation management is complex due to its critical location and deleterious effect when bleeding. Therefore, every case should be thoroughly analyzed preoperatively. We present the case of a female patient with a midbrain cavernous malformation. A comprehensive anatomical and clinical analysis of the surgical corridors is done to decide the safest route. A subtemporal approach was done and the lateral mesencephalic sulcus and vein were important anatomical landmarks to guide the safe entry zone. Nuances of technique and surgical pearls related to the safe entry zones of the midbrain are discussed and illustrated in this operative video.The video can be found here: https://youtu.be/vYA-IgiT2lU.

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Risk Factors for Unfavorable Outcomes in Surgically Treated Brainstem Cavernous Malformations

Cited by 21 publications

References 15 publications

Development and Validation of a Supplementary Grading Scale for Outcomes of Brainstem Cavernous Malformations

Development and Validation of a Supplementary Grading Scale for Outcomes of Brainstem Cavernous Malformations

Mortality in Patients with Brainstem Cavernous Malformations

Subtemporal approach for the resection of a midbrain cavernous malformation: evaluation of safe surgical corridors

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