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Pediatric brainstem cavernous malformations: 2-center experience in 40 children.

Julia Velz1,2,3,4, Sena Özkaratufan1,2, Niklaus Krayenbühl1,2,3

  • 11Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Switzerland.

Journal of Neurosurgery. Pediatrics
|March 18, 2022
PubMed
Summary

Brainstem cavernous malformations (BSCMs) in children show variable clinical courses. Early surgical consideration is advised for aggressive, accessible BSCMs in young patients for better long-term outcomes.

Keywords:
BSCMbrainstem cavernous malformationchildrennatural courseoutcomepediatric patientssurgeryvascular disorders

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Area of Science:

  • Pediatric Neurosurgery
  • Vascular Neurology
  • Pediatric Neurology

Background:

  • Brainstem cavernous malformations (BSCMs) are rare, low-flow vascular lesions in children.
  • Clinical management guidelines for pediatric BSCMs are lacking, with surgical decisions often based on individual surgeon experience.

Purpose of the Study:

  • To evaluate the clinical behavior of pediatric BSCMs.
  • To assess the long-term outcomes of both conservative and surgical management for childhood BSCMs.

Main Methods:

  • Observational, retrospective study.
  • Involved children with BSCMs followed at two institutions from 2008 to 2020.

Main Results:

  • 40 children (mean age 11.4 years) were included; 57.5% managed conservatively, 42.5% surgically.
  • 32.5% experienced aggressive clinical courses with multiple hemorrhages and neurological decline.
  • 90% had favorable long-term outcomes (mRS 0-2); 10% had unfavorable outcomes (mRS 3-4).

Conclusions:

  • Pediatric BSCMs exhibit a highly variable clinical course, ranging from benign to aggressive with recurrent hemorrhages.
  • Early surgical intervention should be considered for accessible, aggressive BSCMs in children due to their potential for greater life expectancy and functional recovery.
  • Management in high-volume centers is recommended for optimal outcomes.