The BSCM score: a guideline for surgical decision-making for brainstem cavernous malformations

Area of Science:

• Neurosurgery
• Neurology
• Medical Informatics

Background:

• Microsurgical resection of brainstem cavernous malformations (BSCMs) is feasible but challenging due to the eloquent location.
• Indications for surgical intervention in BSCMs require careful consideration.

Purpose of the Study:

• To develop a novel scoring system to aid clinicians in treatment decision-making for patients with BSCMs.
• To identify key factors influencing the choice between surgical and conservative management of BSCMs.

Main Methods:

• A single-center study included 88 patients with BSCMs and 272 follow-up visits.
• Generalized estimating equations (GEE) were used for univariable and multivariable analyses to identify significant factors.
• A score scale was developed based on variables significantly associated with treatment decisions.

Main Results:

• Patient age, lesion size, history of hemorrhage, modified Rankin Scale (mRS) score, and axial location were significant factors in treatment decisions.
• The proposed score scale (grades 0-XII) differentiated recommendations: non-surgery for grades 0-III, a crossover between grades V-VI, and surgery favored for grades VII-X.
• Conservative treatment was recommended in 235 instances, while surgical treatment was advised in 37 instances.

Conclusions:

• The developed Brainstem Cavernous Malformation (BSCM) operating score is a practical tool for neurosurgeons.
• This score can assist in making informed treatment choices for patients diagnosed with BSCMs.
• The score aims to optimize management strategies in this challenging neurosurgical condition.