A single institution series of cavernomas of the brainstem

Menon, Girish; Gopalakrishnan, Chittur Viswanathan; Rao, B. Madhusudhana; Nair, Suresh; Sudhir, Jayanand; Sharma, Mridul

doi:10.1016/j.jocn.2011.01.022

Cited by 33 publications

(30 citation statements)

References 32 publications

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“…53,54 Several studies have revealed that patients have a decreased opportunity to recover to their prior neurological statuses after multiple hemorrhages, particularly when neurological function is damaged by the lesions rather than being impaired due to a space-occupying effect or compression. 36,41,48,49,54,56,64 In contrast to surgical series, a study by Kupersmith et al 43 showed a relative- ly low annual rehemorrhage rate of 5.1% in 37 patients who did not receive treatment. They concluded that rehemorrhage was not common among patients who first presented with bleeding and that rehemorrhage often had little effect on neurological status.…”

Section: Natural Historymentioning

confidence: 96%

“…The surgical indications were as follows: 1) multiple hemorrhages (≥ 2), 4,32,54,59 lesion size (lesion equivalent diameter) ≥ 2 cm, and serious or progressive neurological deficit; 13,46,49,53,59,69 2) lesion location in the medulla oblongata; 39,60,69 3) acute or subacute hemorrhage with a significant mass effect; and 4) exophytic lesion or one abutting the pial surface accessible via the "safe entry zones." 32,46,49,54,59,65,69 The lesion size was evaluated as the lesion equivalent diameter (abc) 1/3 , where a, b, and c represent the 3 diameter measurements obtained, respectively, on axial, sagittal, and coronal MR images. Surgery was not recommended for patients with lesions that gradually diminished in size or whose hematomas disappeared.…”

Section: Hemorrhage Definition and Surgical Indicationsmentioning

confidence: 99%

“…However, poor outcomes were reported by other conservative groups who found that only 46.7%-51.8% patients had improved or maintained the same status. 28,49,68 Preoperative hemorrhage risks are still the subject of controversy and have been insufficiently studied. Several factors have been correlated with hemorrhage, including sex (female), 6,9,51,63,69 age, 3,6,12,43 lesion location (deep-seated lesions), 17,41,44,56 large lesion size, 43 a history of previous ictus, 6,7,25,28,[40][41][42][43]56,57,66 and associated DVA.…”

Section: Natural Historymentioning

confidence: 99%

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Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Yang

Hao

et al. 2013

JNS

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Object The aim of this study was to evaluate the pre- and postoperative rehemorrhage risk, neurological function outcome, and prognostic factors of surgically treated brainstem cavernous malformations (CMs) with long-term follow-up. Methods The authors conducted a retrospective review of the clinical data from 242 patients with brainstem CMs that were surgically treated between 1999 and 2010. Patient charts, imaging findings, and outcomes were examined. Results The study included 242 patients, with a male-to-female ratio of 1.3 and mean age of 32.6 years. The mean modified Rankin Scale scores on admission, at discharge, at 3 and 6 months after surgery, and at recent evaluation were 2.2, 2.6, 2.3, 1.8, and 1.5, respectively. The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0% and 60.9%, respectively. The complete resection rate was 95%. Surgical morbidity occurred in 112 patients (46.3%). Eighty-five patients (35.1%) demonstrated worsened condition immediately after surgery; 34 (41.0%) and 51 (61.4%) of these patients recovered to their baseline level within 3 and 6 months after surgery, respectively. At a mean follow-up of 89.4 months, the patients' condition had improved in 147 cases (60.7%), was unchanged in 70 cases (28.9%), and had worsened in 25 cases (10.3%). A total of 8 hemorrhages occurred in 6 patients, and the postoperative annual hemorrhage rate was 0.4%. Permanent morbidity remained in 65 patients (26.9%). The adverse factors for preoperative rehemorrhage were age ≥ 50 years, size ≥ 2 cm, and perilesional edema. The risk factors for postoperative hemorrhage were developmental venous anomaly and incomplete resection. The independent adverse factors for long-term outcome were increased age, multiple hemorrhages, ventral-seated lesions, and poor preoperative status. Favorable, complete improvement in the postoperative deficits over time was correlated with good preoperative neurological function and continuing improvement thereafter. Conclusions Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates were achieved via surgery. Total resection should be attempted with an aim of minimal injury to neurological function; however, postoperative deficits can improve during the postoperative course. Close follow-up with radiological examination is proposed for patients with adverse factors predictive of rehemorrhage.

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Section: Natural Historymentioning

confidence: 96%

Section: Hemorrhage Definition and Surgical Indicationsmentioning

confidence: 99%

Section: Natural Historymentioning

confidence: 99%

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Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Yang

Hao

et al. 2013

JNS

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“…10,11,14,19,22,30,34,37,38,42,47,51 Among these studies, Tarnaris et al 47 reported fairly poor outcomes, with 53.3% of patients exhibiting worsening conditions, and cited a neurological deterioration of 10% per patient year. An extremely malignant prognosis was reported with a mortality rate of 20%.…”

Section: Functional Outcomesmentioning

confidence: 99%

“…22 In contrast, acceptable outcomes were described in several series, stating that the natural history of brainstem CMs appeared to be more benign than previously believed. 14,19,30,34 Overall, in 7 series that provided detailed outcomes, 11,19,30,38,42,47,51 88 (71.5%) of 123 patients were improved/unchanged, 33 patients (26.8%) worsened, and the mortality rate due to rehemorrhage was 4.1% (9/218). Another series consisting exclusively of 13 pediatric brainstem CMs revealed no change in function in 8 patients (61.5%) and improvement in 4 patients (30.8%).…”

Section: Functional Outcomesmentioning

confidence: 99%

Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery

Li¹,

Hao²,

Tang³

et al. 2014

PED

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Object The aim of this study was to investigate the clinical appearance of untreated pediatric brainstem cavernous malformations (CMs) and to identify the hemorrhage risks and functional outcomes. Methods All pediatric patients with a diagnosis of brainstem CM between 1985 and 2012 were registered. The clinical chart and radiographs were recorded, and follow-up evaluations were obtained prospectively. Results A total of 85 patients (69.4% male) were included with a mean age of 12.7 years. Sixty-seven patients (78.8%) had prior hemorrhage, and 6 patients (7.1%) were asymptomatic. There were 15 midbrain lesions, 53 pons lesions, and 17 medulla lesions. The mean lesion size was 1.9 cm. During a total of 401.6 patient-years of follow-up, 47 hemorrhages occurred in 37 patients, and the annual hemorrhage rate was 11.7% per patient-year. The mean hemorrhage interval was 47.8 months. The hemorrhage risk declined over time, especially after the first 2 years. Both a lesion size ≥ 2 cm (hazard ratio [HR] 2.122, p = 0.037) and the presence of perilesional edema (HR 2.192, p = 0.039) predicted future hemorrhage and were associated with a high annual hemorrhage rate. The hemorrhage-free survival at 6 months was 85.7%, and at 1, 5, 10, and 15 years was 71.5%, 49.4%, 27.5%, and 13.7%, respectively. At the most recent functional evaluation, 33 patients (38.8%) had improved, 32 (37.6%) had stabilized, and 20 (23.5%) had worsened, without any deaths. Twenty-two patients (25.9%) obtained a full recovery. Prospective hemorrhage (HR 0.191, p = 0.003) was the adverse predictor for full recovery. Full recovery primarily occurred within the first 12 months, after which the chance of full recovery decreased. The cumulative percentage of complete recovery at 6 months was 32.7%, and at 1, 3, and 5 years was 40.8%, 43.6%, and 49.2%, respectively. Conclusions In this study the hemorrhage rate was relatively high in pediatric brainstem CMs, although the functional outcome was acceptable. The decline in hemorrhage risk and the identified adverse predictors in this study were helpful for clinicians and patients when deciding on treatment. Referral bias and the insufficient follow-up period of the study were highlighted as limitations.

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Safe Entry Zones for Brainstem Cavernomas

Nathal

2020

Principles of Neuro-Oncology

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A single institution series of cavernomas of the brainstem

Cited by 33 publications

References 32 publications

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Clinical course of untreated pediatric brainstem cavernous malformations: hemorrhage risk and functional recovery

Safe Entry Zones for Brainstem Cavernomas

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