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Rebleeding and Outcome in Patients with Symptomatic Brain Stem Cavernomas.
Antonio Arauz1, Hernán M Patiño-Rodriguez, Mónica Chavarria-Medina
1Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
Cerebrovascular Diseases (Basel, Switzerland)
|March 21, 2017
Summary
Brain stem cavernous malformations (BCMs) larger than 18 mm significantly increase rebleeding risk. While overall outcomes are good, rebleeding leads to significant patient morbidity.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Brain stem cavernous malformations (BCMs) are vascular anomalies that can cause hemorrhage.
- Understanding long-term outcomes and rebleeding risk factors is crucial for patient management.
Purpose of the Study:
- To evaluate long-term functional outcomes in patients with brain stem cavernous malformations (BCMs) after hemorrhage.
- To identify risk factors associated with rebleeding in surgically or conservatively treated BCM patients.
Main Methods:
- Prospective monitoring of 99 patients with first hemorrhagic episodes from single BCMs.
- Neurological status assessed using the modified Rankin score (mRS).
- Univariate and multivariate regression analyses to determine rebleeding risk factors.
Main Results:
- A lesion size greater than 18 mm was the primary risk factor for hemorrhage recurrence (HR 2.7, p=0.016).
- Rebleeding significantly correlated with poorer functional outcomes (favorable mRS 33.3% vs. 65.3% without rebleeding).
- The rebleeding rate was 10% per patient/year in conservatively treated patients.
Conclusions:
- Lesion size >18 mm is the principal factor predicting hemorrhage recurrence in BCMs.
- While overall functional outcomes can be good, rebleeding contributes to significant patient morbidity.
- Effective risk stratification is essential for managing BCMs.
