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Cavernous malformations of the central nervous system: An international consensus statement
Anastasia Tasiou1, Alexandros G Brotis1, Adamantios Kalogeras1
1Department of Neurosurgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece.
Brain & Spine
|November 29, 2023
Summary
This study established expert consensus on managing central nervous system cavernous malformations (CMs). Key factors for treatment decisions include patient age, symptoms, and CM characteristics, guiding neurosurgical interventions.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Central nervous system cavernous malformations (CMs) are rare vascular lesions.
- Their management is often debated due to asymptomatic presentation and controversial treatment strategies for symptomatic cases.
Purpose of the Study:
- To establish an expert consensus on the optimal management of asymptomatic and symptomatic central nervous system cavernous malformations.
- To guide neurosurgeons in decision-making processes for CM treatment.
Main Methods:
- A 17-item questionnaire addressing controversial aspects of CM treatment was developed.
- A three-stage Delphi process involving 19 experts was conducted to reach consensus.
- A 70% agreement rate was set as the threshold for consensus.
Main Results:
- Consensus was reached on factors influencing surgical intervention: patient age, symptomatology, hemorrhagic recurrence, CM location, and size.
- Advanced MRI techniques are valuable for surgical planning.
- Observation is common for asymptomatic eloquent or deep-seated CMs; resection is considered for symptomatic or recurrently bleeding deep-seated CMs.
- Asymptomatic hemorrhages and developmental venous anomalies without hemosiderin are not indications for resection.
Conclusions:
- The Delphi consensus provides a framework for expert common practice in managing challenging cases of central nervous system cavernous malformations.
- This consensus aids in navigating complex treatment decisions for CM patients.
