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Multimodal outcome assessment after surgery for brainstem cavernous malformations.

Philipp Dammann1, Annika Herten1, Alejandro N Santos1

  • 11Department of Neurosurgery, University Hospital Essen.

Journal of Neurosurgery
|October 16, 2020
PubMed
Summary

Surgery for brainstem cavernous malformations (BSCMs) impacts health-related quality of life (HRQOL) and psychological well-being. Absolute outcome measures are best for assessing BSCM surgery results.

Keywords:
CCM; cerebral cavernous malformationHRQOLbrainstem cavernous malformationcavernous angiomafunctional outcomehealth-related quality of lifesurgeryvascular disorders

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Area of Science:

  • Neurosurgery
  • Neurology
  • Quality of Life Research

Background:

  • Brainstem cavernous malformations (BSCMs) present unique surgical challenges.
  • Assessing surgical outcomes requires evaluating functional status, quality of life, and psychological well-being.

Purpose of the Study:

  • To evaluate outcomes after BSCM surgery using functional, health-related quality of life (HRQOL), and psychological assessments.
  • To analyze the interrelation of these outcome measures.
  • To compare HRQOL and psychological scores with a healthy population.

Main Methods:

  • Cross-sectional outcome study of 74 surgically treated BSCM patients (2003-2019).
  • Assessed functional outcome (mRS), HRQOL (SF-36, LISAT-9), cranial nerve/brainstem function, and psychological status (HADS).
  • Compared outcomes with healthy population data and analyzed correlation between absolute and relative outcome endpoints.

Main Results:

  • Post-BSCM surgery HRQOL was impaired compared to healthy individuals, significantly in unfavorable outcomes (mRS > 2) but also in selected domains for favorable outcomes (mRS ≤ 2).
  • Psychological impairment was negligible in favorable outcomes and severe in unfavorable outcomes.
  • Balance impairment significantly impacted HRQOL; absolute outcome endpoints better reflected HRQOL impairment than relative ones.

Conclusions:

  • Study data can enhance patient counseling and decision-making for BSCM treatment.
  • Absolute outcome endpoints are recommended for reporting BSCM surgery outcomes.
  • Emphasizes the specific impact of cranial nerve and brainstem symptoms on HRQOL.