Hemorrhage risks and functional outcomes of untreated brainstem cavernous malformations

Area of Science:

• Neurology
• Neurosurgery
• Vascular Malformations

Background:

• Cerebral cavernous malformations (CMs) are increasingly studied, yet the natural history and hemorrhage risks of brainstem CMs remain poorly defined.
• Hemorrhages from brainstem CMs can lead to devastating neurological deficits.

Purpose of the Study:

• To quantify the hemorrhage risks associated with brainstem cavernous malformations.
• To evaluate the functional outcomes and identify predictors of recovery in patients with brainstem CMs.

Main Methods:

• A prospective, longitudinal cohort study involving 331 patients diagnosed with brainstem CMs between 1985 and 2012.
• Recording of clinical courses, evaluation of hemorrhage predictors, and assessment of untreated outcomes.
• Mean follow-up duration of 6.5 years.

Main Results:

• Annual hemorrhage rates varied: 15.9% (with deficits), 12.4% (without deficits), and 8.7% (no prior hemorrhage).
• Risk factors for hemorrhage included female sex (HR 1.445), prior hemorrhage (HR 1.277), and perilesional edema (HR 1.830).
• Most patients (92.7%) improved or stabilized; predictors of complete recovery were no prior hemorrhage, younger age, and smaller lesion size.

Conclusions:

• Initial patient presentation is a key predictor of future hemorrhage rates in brainstem CMs.
• Identified risk factors and outcome predictors can aid clinicians in assessing hemorrhage potential and personalizing treatment strategies.