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Updated: Dec 31, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Surgical managements and patient outcomes after severe hemorrhagic events from brainstem cavernous malformations
Sungel Xie1,2, Xin-Ru Xiao3, Shun-Wu Xiao1
1Department of Neurosurgery, the Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Insights
Surgery for brainstem cavernous malformations (CMs) can yield favorable outcomes. Optimal timing for surgical intervention, particularly during the subacute hemorrhage phase (3-8 weeks), appears to improve results for patients experiencing severe bleeding events.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurology
Background:
- Brainstem cavernous malformations (CMs) pose significant risks due to potential severe hemorrhagic events.
- Surgical intervention is a critical treatment option for symptomatic brainstem CMs.
- The optimal timing for surgical intervention following a hemorrhage remains a key clinical question.
Purpose of the Study:
- To evaluate surgical outcomes and predictors in patients with severe brainstem CM hemorrhage.
- To investigate the impact of surgical timing on long-term outcomes after severe bleeding from brainstem CMs.
Main Methods:
- Retrospective review of clinical data from 61 patients surgically treated for severe brainstem CM hemorrhage (2011-2017).
- Patients were categorized by surgical timing: acute (<3 weeks), subacute (≥3-8 weeks), and chronic (>8 weeks) post-hemorrhage.
- Logistic regression analysis was used to identify predictors of long-term outcomes, assessed by modified Rankin Scale (mRS).
Main Results:
- The mean admission mRS score was 4.2; at a mean follow-up of 39.8 months, 63.9% achieved a favorable outcome (mRS ≤2).
- Age, disrupted consciousness/respiration, and time to surgery were significant outcome predictors.
- Surgery in the acute (<3 weeks) or chronic (>8 weeks) periods was associated with poorer outcomes compared to the subacute (≥3-8 weeks) period.
Conclusions:
- Favorable neurological outcomes are achievable following surgical treatment for severe brainstem CM hemorrhage.
- Surgical intervention during the subacute hemorrhage phase (≥3-8 weeks) may offer significant benefits for patient outcomes.
- Timing of surgery is a crucial factor influencing long-term results in brainstem CM management.
Abstract:
To evaluate the surgical outcomes and predictors and the impact of surgical timing of patients who suffered a severe hemorrhagic event from brainstem cavernous malformations (CMs). The clinical data of all patients who underwent surgical treatment after a severe bleeding ictus from brainstem CMs between 2011 and 2017 were retrospectively reviewed. The study population consisted of 61 surgical patients (40, 65.6% female). Surgical times of < 3 weeks, ≥ 3-8 weeks, and > 8 weeks since the last bleeding ictus were observed in 23 (37.7%), 24 (39.3%), and 14 (23.0%) patients, respectively. The mean modified Rankin scale (mRS) score evaluated on admission was 4.2. With a mean follow-up of 39.8 months, 39 patients (63.9%) had a favorable outcome (mRS ≤ 2), and the mean mRS score was 2.3. The logistic regression analysis identified age, having disrupted consciousness and/or respiration, and time to surgery from last hemorrhage as significant predictors of long-term outcome. In particular, patients with surgery performed during the acute period (< 3 weeks, P = 0.06) or chronic period (> 8 weeks, P = 0.01) tended to have poor outcomes when compared with those with surgery during the subacute period (≥ 3-8 weeks). Favorable neurological outcomes can be achieved in patients who were surgically treated after a severe hemorrhagic ictus from brainstem CMs, and operation during subacute hemorrhage (≥ 3-8 weeks) could benefit these patients.
