Successful treatment of hemorrhagic brainstem cavernous malformation with hematoma evacuation and postoperative propranolol

Hoffman, Jessa; Ryan, Megan; Wittenberg, Blake; Armstrong, Jennifer; Greenan, Krista; Wilkinson, Corbett

doi:10.1007/s00381-020-04588-5

Cited by 7 publications

(3 citation statements)

References 12 publications

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“…In addition, they may benefit from medical management with beta-blockers (e.g., propranolol) or emerging pharmacological agents designed to reduce hemorrhagic activity. 43,44 acceptable surgical results in this study (good outcomes in 75% of patients and worsening in 16%) and should also be carefully considered for microsurgical resection.…”

Section: Clinical Interpretationmentioning

confidence: 70%

External validation of the Lawton brainstem cavernous malformation grading system in a cohort of 277 microsurgical patients

Catapano

Rutledge

Rumalla

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The brainstem cavernous malformation (BSCM) grading system predicts neurological outcomes associated with microsurgical resection and assists neurosurgeons in selecting patients for treatment. The predictive accuracy of the BSCM grading system should be validated in a large cohort from high-volume centers to generalize its use. METHODS An external validation cohort comprised patients with a BSCM resected by the senior author (M.T.L.) since the publication of the BSCM grading system and those resected by another neurosurgeon (R.F.S.) over a 16-year period. Size, crossing the axial midpoint, the presence of a developmental venous anomaly, patient age, and timing of last hemorrhage were used to assign BSCM grades from 0 to VII. Poor neurological outcomes were recorded as modified Rankin Scale scores > 2 at last follow-up examination. RESULTS A total of 277 patients were included in the study. The average BSCM grade was 3.9, and the majority of BSCMs (181 patients, 65%) were intermediate grade (grades III–V). Outcomes were predicted by BSCM grade, with good outcomes observed in 47 of 54 patients (87%) with low-grade BSCMs, in 135 of 181 patients (75%) with intermediate-grade BSCMs, and in 21 of 42 patients (50%) with high-grade BSCMs. Conversely, proportions of patients with neurological deterioration increased with increasing BSCM grade, with worsening observed in 2 of 54 patients (4%) with low-grade BSCMs, in 29 of 181 patients (16%) with intermediate-grade BSCMs, and in 17 of 42 patients (40%) with high-grade BSCMs. In the chi-square analysis, high-grade BSCMs were associated with increased odds of neurological worsening compared to low- and intermediate-grade BSCMs (OR 5.0, 95% CI 2.4–10.4; p < 0.001). The receiver operating characteristic analysis demonstrated acceptable discrimination for predicting unfavorable functional outcomes (modified Rankin Scale score > 2) with an area under the curve of 0.74 (95% CI 0.68–0.80; p < 0.001). CONCLUSIONS This study validates the BSCM grading system in a large cohort of patients from two high-volume surgeons. BSCM grade predicted neurological outcomes with accuracy comparable to that of other grading systems in widespread use. The BSCM grading system establishes categories of low-, intermediate-, and high-grade BSCMs and a boundary or cutoff for surgery at BSCM grade V. BSCM grading guides the analysis of a particular patient’s condition, but treatment recommendations must be individualized, and neurosurgeons must calibrate BSCM grading to their own outcome results, unique abilities, and practices.

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Section: Clinical Interpretationmentioning

confidence: 70%

External validation of the Lawton brainstem cavernous malformation grading system in a cohort of 277 microsurgical patients

Catapano

Rutledge

Rumalla

et al. 2022

Journal of Neurosurgery

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show abstract

“…Therefore, it is challenging for neurosurgeons to choose the best surgical approach and technique for the patient prognosis [21]. According to recent studies, there is no speci c recommended treatment for chemotherapy, and there are only examples of researchers using propranolol to treat brainstem cavernous hemangioma [22]. When using radiation therapy, most current studies have been performed using gamma knife radiosurgery or stereotactic radiosurgery [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Survival Analysis of Patients with Brainstem Cavernous Hemangioma: A Population-Based Study Using the SEER Database

Zhan

Jiang

et al. 2022

Preprint

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This population-based study determined the epidemiology, incidence, and outcomes of brainstem cavernous hemangioma. Data on patients with brainstem cavernous hemangioma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Descriptive analysis assessed the distribution and tumor-related characteristics of patients with brainstem cavernous hemangioma. The Kaplan–Meier method and Cox proportional hazard model were used to analyzed the possible prognostic indicators. The age-adjusted incidence rate between 2000 and 2019 was 0.0236 cases per 100,000 person-years. A total of 283 cases of brainstem cavernous hemangioma were identified between 2000 and 2019. The median patient age was 45 years (range, 0–87 years). Most patients were diagnosed between 40–44 and 55–59 years of age. Middle-aged adults (40–59 years old) accounted for 41.34% of all patients. White patients accounted for 82.6% of all patients. All patients diagnosed with brainstem cavernous hemangioma had benign lesions. Surgery was performed in 105 (37.1%) cases, radiation therapy in 5 (1.7%) cases, and chemotherapy in 1(0.4%) case. The median survival time was 71 months (range: 0–189 months). Age at diagnosis and surgery were two strong factors affecting occurrence and prognosis. Incidence did not differ between sexes and was higher in white patients. Tumor size had little impact on early prognosis; however, for late prognosis, smaller tumors (< 3 cm) had a better prognosis. No significant differences were observed in the outcomes between surgery and conservative treatment. We recommend that the treatment of patients with brainstem cavernous hemangioma should be tailored to the patient's situation (e.g., age, tumor size, possible surgical benefit, etc.) and should be individualized after taking into account.

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“…Novel treatments for symptomatic cavernomas suggest a role for propranolol which may work by inhibiting new blood vessel growth [ 31 , 32 ]. Treatment of aggressive lesions with propranolol in select cases has led to partial regression and symptom alleviation; however, similar to SRS, it remains to be seen whether this is a reflection of the pharmacologic intervention or demonstration of the natural history of these lesions [ 31 , 33 ].…”

Section: Pharmacotherapymentioning

confidence: 99%

Tailored Treatment Options for Cerebral Cavernous Malformations

Hoffman

Wittenberg

Morel

et al. 2022

JPM

Self Cite

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The diagnosis and treatment of cerebral cavernous malformations (CCMs), or cavernomas, continues to evolve as more data and treatment modalities become available. Intervention is necessary when a lesion causes symptomatic neurologic deficits, seizures, or has high risk of continued hemorrhage. Future medical treatment directions may specifically target the pathogenesis of these lesions. This review highlights the importance of individualized treatment plans based on specific CCM characteristics.

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Successful treatment of hemorrhagic brainstem cavernous malformation with hematoma evacuation and postoperative propranolol

Cited by 7 publications

References 12 publications

External validation of the Lawton brainstem cavernous malformation grading system in a cohort of 277 microsurgical patients

External validation of the Lawton brainstem cavernous malformation grading system in a cohort of 277 microsurgical patients

Epidemiology and Survival Analysis of Patients with Brainstem Cavernous Hemangioma: A Population-Based Study Using the SEER Database

Tailored Treatment Options for Cerebral Cavernous Malformations

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