Surgical management of pediatric brainstem cavernous malformations

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Vascular Malformations

Background:

• Pediatric brainstem cavernous malformations (CMs) present significant surgical challenges.
• Understanding risk factors for surgical outcomes is critical for effective treatment planning.

Purpose of the Study:

• To evaluate surgical outcomes in pediatric patients with brainstem CMs.
• To identify risk factors associated with postoperative full recovery and rebleeding.

Main Methods:

• Retrospective review of clinical charts and radiographs from 52 pediatric patients (age 1-17) who underwent surgery for brainstem CMs.
• Neurological function assessed using the modified Rankin Scale (mRS).
• Follow-up evaluation measures obtained retrospectively.

Main Results:

• Gross-total resection achieved in 94.2% of patients; 21.2% had persistent surgical morbidities after 7.9 years.
• Postoperative mRS scores significantly improved compared to admission scores by 6 months and recent evaluation.
• Adverse predictors for full recovery included age ≥ 12 years, ≥ 2 preoperative hemorrhages, and poor preoperative status. Incomplete resection predicted rebleeding.

Conclusions:

• Surgery for pediatric brainstem CMs can achieve fair outcomes, but full recovery is limited.
• Tailored surgical planning is essential to minimize morbidity; complete resection is recommended to reduce rebleeding risk.
• Identifying predictors of recovery aids in treatment decisions for pediatric brainstem CMs.