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Hemorrhage from cerebral cavernous malformations: The role of associated developmental venous anomalies

Bixia Chen1, Annika Herten2, Dino Saban2

  • 1From the Department of Neurosurgery (B.C., A.H., D.S., S.R., Y.Z., R.J., K.H.W., U.S., P.D.), Institute of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), Institute for Medical Informatics, Biometry and Epidemiology (B.S.), and Department of Neurology (C.K.), University Hospital Essen, University of Duisburg-Essen, Essen, Germany. bixia.chen@uk-essen.de.

Neurology
|June 10, 2020
PubMed

Insights

Developmental venous anomalies (DVAs) are associated with a lower risk of intracranial hemorrhage (ICH) in patients with cerebral cavernous malformations (CCMs). However, DVAs do not independently alter the long-term risk of hemorrhage in CCM patients.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Cerebral cavernous malformations (CCMs) are vascular malformations that can lead to intracranial hemorrhage (ICH).
  • Developmental venous anomalies (DVAs) are often found incidentally alongside CCMs.
  • The role of DVAs in the clinical presentation and prognosis of CCMs remains incompletely understood.

Purpose of the Study:

  • To investigate the influence of associated DVAs on the occurrence of ICH in patients diagnosed with CCMs.
  • To assess the impact of DVAs on the risk of future hemorrhage events in CCM patients.

Main Methods:

  • Analysis of a registry of 731 patients with CCMs treated between 2003 and 2018.
  • Multivariate logistic regression to evaluate predictors of ICH presentation.
  • Kaplan-Meier and Cox regression analyses to determine cumulative 5-year hemorrhage risk and identify prognostic factors.

Main Results:

  • A negative correlation was found between the presence of DVA and ICH presentation (OR 0.635).
  • Brainstem localization was positively correlated with ICH presentation (OR 6.277).
  • Initial ICH presentation and brainstem localization were independent predictors of recurrent hemorrhage, while DVA presence did not add independent prognostic value.

Conclusions:

  • Associated DVAs may reduce the likelihood of initial ICH presentation in patients with CCMs.
  • The long-term risk of hemorrhage in CCM patients with associated DVAs is comparable to those without DVAs when not treated.
  • Brainstem location is a significant risk factor for both initial presentation and recurrent hemorrhage in CCM patients.
Abstract

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