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Surgery for cerebral cavernous malformations: a systematic review and meta-analysis
Lauren Harris1, Michiel H F Poorthuis2, Patrick Grover3
1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. lauren.harris7@nhs.net.
Neurosurgical Review
|June 30, 2021
Summary
The surgical risks for cerebral cavernous malformations (CCMs) include death, hemorrhage, or neurological deficit, occurring at approximately 4%. These risks are elevated for brainstem CCMs and those presenting with hemorrhage, with no change over time.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Epidemiology
Background:
- Cerebral cavernous malformations (CCMs) are vascular malformations in the brain.
- Neurosurgical excision is a treatment option for CCMs, but carries risks.
- Quantifying these risks is crucial for patient management.
Purpose of the Study:
- To systematically review and quantify the risks associated with neurosurgical excision of cerebral cavernous malformations (CCMs).
- To update previous systematic reviews on CCM surgery outcomes.
Main Methods:
- Updated systematic review of cohort studies from January 2013 to April 2019.
- Searched OVID Medline, OVID EMBASE, and Cochrane Library.
- Primary outcome: composite of death, symptomatic intracerebral hemorrhage (ICH), or new/worsened focal neurological deficit (FND).
Main Results:
- Included 70 cohorts with 5,089 patients undergoing surgery.
- Annual composite outcome rate was 4.2%, higher for brainstem CCM (6.0%) vs. supratentorial CCM (2.4%).
- Higher rates observed in CCMs presenting with ICH (6.1%) vs. others (2.3%); no change in incidence over time.
Conclusions:
- The overall annual risk of death, ICH, or FND after CCM excision is approximately 4%.
- Risk is significantly higher for brainstem CCM and CCMs that have previously caused ICH.
- These risks have remained consistent over time.
