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Induction and Micro-CT Imaging of Cerebral Cavernous Malformations in Mouse Model
Published on: September 4, 2017
Recurrence of cavernous malformations after surgery in childhood
Laura M Prolo1, Michael C Jin1, Tina Loven2
1Departments of1Neurosurgery and.
Insights
Pediatric cavernous malformations (CMs) with hemorrhage or multiple lesions require closer monitoring post-surgery due to higher risks of recurrence. Single CMs in children typically have favorable outcomes with less need for frequent imaging.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Neurology
Background:
- Cavernous malformations (CMs) are prevalent cerebrovascular anomalies in children.
- Limited data exists on the radiographic recurrence of pediatric CMs post-surgery.
- Understanding recurrence risk is crucial for optimizing patient management and surveillance strategies.
Purpose of the Study:
- To investigate the clinical presentation, surgical outcomes, and recurrence rates of pediatric cavernous malformations.
- To identify prognostic factors associated with the need for subsequent surgeries in children with CMs.
- To inform long-term surveillance protocols based on patient-specific risk factors.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) who underwent CM resection.
- Analysis of clinical data, including presentation, lesion characteristics, and surgical history.
- Statistical analysis using Fisher's exact test and Mantel-Cox survival curves.
Main Results:
- 74 symptomatic CMs were resected in 53 pediatric patients over 22 years; median follow-up was 5.65 years.
- Seizures and cortical locations were common presentations; acute radiographic hemorrhage occurred in 64.2%.
- Multiple CMs and radiographic hemorrhage independently predicted higher risk for subsequent surgery, with 50% of high-risk patients needing re-operation within 2.5 years.
Conclusions:
- Children with radiographic hemorrhage or multiple CMs face elevated risks for requiring additional surgery.
- Long-term MRI surveillance is recommended for pediatric patients with hemorrhage or multiple CMs.
- Patients with single CMs generally have favorable outcomes and may require less intensive imaging follow-up.
Objective:
Cavernous malformations (CMs) are commonly treated cerebrovascular anomalies in the pediatric population; however, the data on radiographic recurrence of pediatric CMs after surgery are limited. The authors aimed to study the clinical presentation, outcomes, and recurrence rate following surgery for a large cohort of CMs in children.
Methods:
Pediatric patients (≤ 18 years old) who had a CM resected at a single institution were identified and retrospectively reviewed. Fisher's exact test of independence was used to assess differences in categorical variables. Survival curves were evaluated using the Mantel-Cox method.
Results:
Fifty-three patients aged 3 months to 18 years underwent resection of 74 symptomatic CMs between 1996 and 2018 at a single institution. The median length of follow-up was 5.65 years. Patients most commonly presented with seizures (45.3%, n = 24) and the majority of CMs were cortical (58.0%, n = 43). Acute radiographic hemorrhage was common at presentation (64.2%, n = 34). Forty-two percent (n = 22) of patients presented with multiple CMs, and they were more likely to develop de novo lesions (71%) compared to patients presenting with a single CM (3.4%). Both radiographic hemorrhage and multiple CMs were independently prognostic for a higher risk of the patient requiring subsequent surgery. Fifty percent (n = 6) of the 12 patients with both risk factors required additional surgery within 2.5 years of initial surgery compared to none of the patients with neither risk factor (n = 9).
Conclusions:
Patients with either acute radiographic hemorrhage or multiple CMs are at higher risk for subsequent surgery and require long-term MRI surveillance. In contrast, patients with a single CM are unlikely to require additional surgery and may require less frequent routine imaging.
