Impact of Timing of Intervention Among 397 Consecutively Treated Brainstem Cavernous Malformations

Neurosurgery. 2017 Oct 1;81(4):620-626. doi: 10.1093/neuros/nyw139.

Abstract

Background: Surgical resection of brainstem cavernous malformations (BSCMs) is challenging, and patient selection and timing of intervention remain controversial.

Objective: To evaluate the impact of surgical timing and predictors of neurological outcome after surgical resection of BSCMs.

Methods: Consecutive adult patients (≥18 years) with BSCMs undergoing surgical resection between 1985 and 2014 by the senior author (RFS) were retrospectively reviewed. Patient demographics, lesion characteristics, imaging results, surgical approach, and perioperative and long-term neurological morbidity were analyzed.

Results: Data were analyzed for a total of 397 adult patients (160, 40% male). On univariate analysis, a greater proportion of patients treated within 6 weeks of hemorrhage had an improved Glasgow Outcome Scale score (P = .06). On logistic regression analysis, patients treated within 6 weeks of hemorrhage experienced improved clinical outcomes (odds ratio = 1.73; 95% confidence interval = 1.06-2.83; P = .03).

Conclusions: Although BSCM surgery is associated with significant perioperative morbidity and mortality, favorable long-term hemorrhage rates and symptom resolution can be achieved in a carefully selected group of patients. Overall, patients treated acutely, within 6 weeks, benefited the most from surgical intervention.

Keywords: Brainstem; Cavernoma; Cavernous malformation; Operator experience; Timing.

MeSH terms

  • Adult
  • Aged
  • Brain Stem / pathology
  • Brain Stem / surgery
  • Brain Stem Neoplasms / diagnosis*
  • Brain Stem Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Hemangioma, Cavernous, Central Nervous System / diagnosis*
  • Hemangioma, Cavernous, Central Nervous System / surgery*
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome