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Updated: Aug 11, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Functional outcome after pediatric cerebral cavernous malformation surgery
Laurèl Rauschenbach1,2, Alejandro N Santos3,4, Thiemo F Dinger3,4
1Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany. laurel.rauschenbach@uk-essen.de.
Insights
Surgical resection of pediatric cerebral cavernous malformations (CCM) is generally safe, with most patients showing improved functional outcomes. However, brainstem CCMs present a high risk for postoperative complications, requiring careful surgical consideration.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Malformations
Background:
- Cerebral cavernous malformations (CCM) are vascular anomalies that can cause neurological symptoms in children.
- Surgical resection is a treatment option, but functional outcomes and predictors of complications require further investigation in pediatric populations.
Purpose of the Study:
- To evaluate the functional outcomes after surgical resection of pediatric cerebral cavernous malformations (CCM).
- To identify predictors of postoperative functional deterioration in pediatric CCM patients.
Main Methods:
- Retrospective analysis of pediatric patients (≤18 years) with CCM treated between 2003-2021.
- Functional outcome assessed using the modified Rankin Scale (mRS) at admission, discharge, and last follow-up.
- Logistic regression analysis used to identify predictors of postoperative deterioration.
Main Results:
- 49 pediatric patients included; 89.8% achieved complete resection.
- Mean mRS score improved from 1.6 at admission to 0.9 at last follow-up.
- Brainstem localization was a significant predictor of postoperative functional deterioration (aOR=53.45, p=0.014).
Conclusions:
- Surgical CCM removal in children is generally safe and effective, leading to favorable functional outcomes for most.
- Brainstem localization is associated with a high risk of morbidity, necessitating careful consideration of surgical indications.
- Second-look surgery for CCM remnants may be a safe and beneficial option.
Abstract:
The purpose of this study was to investigate the functional outcome following surgical resection of cerebral cavernous malformations (CCM) in pediatric patients. We screened our institutional database of CCM patients treated between 2003 and 2021. Inclusion regarded individuals younger or equal than 18 years of age with complete clinical baseline characteristics, magnetic resonance imaging dataset, and postoperative follow-up time of at least three months. Functional outcome was quantified using the modified Rankin Scale (mRS) score and assessed at admission, discharge, and last follow-up examination. The primary endpoint was the postoperative functional outcome. As a secondary endpoint, predictors of postoperative functional deterioration were assessed. A total of 49 pediatric patients with a mean age of 11.3 ± 5.7 years were included for subsequent analyses. Twenty individuals (40.8%) were female. Complete resection of the lesion was achieved in 44 patients (89.8%), and two patients with incomplete resection were referred for successive remnant removal. The mean follow-up time after surgery was 44 months (IQR: 13 - 131). The mean mRS score was 1.6 on admission, 1.7 at discharge, and 0.9 at the latest follow-up. Logistic regression analysis adjusted to age and sex identified brainstem localization (aOR = 53.45 [95%CI = 2.26 - 1261.81], p = .014) as a predictor of postoperative deterioration. This study indicates that CCM removal in children can be regarded as safe and favorable for the majority of patients, depending on lesion localization. Brainstem localization implies a high risk of postoperative morbidity and indication for surgery should be balanced carefully. Minor evidence indicates that second-look surgery for CCM remnants might be safe and favorable.
