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Published on: January 27, 2015
Natural history of brainstem cavernous malformations
M J Kupersmith1, H Kalish, F Epstein
1Institute of Neurology and Neurosurgery, Beth Israel Medical Center, New York, New York, USA. mkuper@bethisraelny.org
Neurosurgery
|January 11, 2001
Summary
Brainstem cavernous malformations (cavernomas) have a 2.46% annual bleeding rate, with rebleeding occurring at 5.1%/yr. Older patients and smaller lesions indicate a lower risk of bleeding episodes.
Area of Science:
- Neurology
- Neurosurgery
- Ophthalmology
Background:
- Brainstem cavernous malformations (cavernomas) are vascular malformations that can cause significant neurological deficits.
- Understanding their natural history, particularly hemorrhage rates, is crucial for patient management.
Purpose of the Study:
- To determine the natural history and hemorrhage rates of brainstem cavernomas.
- To analyze factors influencing bleeding risk and patient outcomes.
Main Methods:
- Retrospective review of 37 patients with brainstem cavernomas evaluated between 1987 and 1999.
- Assessment of clinical symptoms, disability grade, and magnetic resonance imaging (MRI) findings.
- Calculation of annual bleeding and rebleeding rates.
Main Results:
- A total of 39 bleeding episodes occurred in 31 patients over a mean follow-up of 4.9 years, yielding a bleeding rate of 2.46%/year.
- Rebleeding occurred in 8 patients at a rate of 5.1%/year. Patients aged ≥35 years had a lower bleeding risk (OR, 0.15).
- Cavernomas ≥10 mm were associated with a higher bleeding risk (OR, 3.48). Significant morbidity occurred in 8% of patients.
Conclusions:
- Brainstem cavernomas exhibit a low annual bleeding rate, with rebleeding not being more frequent in those who initially presented with bleeding.
- Age and cavernoma size are significant predictors of bleeding risk.
- Most patients experienced minimal neurological impact from cavernomas during the follow-up period.
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