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Treatment Modalities and Outcomes in Brainstem Cavernous Malformations: A Large Multicenter Observational Cohort
Junlin Lu1, Zongze Li2,3,4,5,6, Hao Deng1
1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China (J.L., H.D., W.W., C.Y., R.T.).
Stroke
|March 26, 2024
Summary
Microsurgery and stereotactic radiosurgery (SRS) show similar safety and effectiveness for brainstem cavernous malformations (BSCMs), with both outperforming conservative management in preventing recurrent hemorrhage.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Malformations
Background:
- Symptomatic brainstem cavernous malformations (BSCMs) present significant risks of hemorrhage, morbidity, and mortality.
- Effective management strategies for BSCMs are crucial, yet comparative studies on treatment modalities are limited.
Purpose of the Study:
- To compare the effectiveness of microsurgery versus stereotactic radiosurgery (SRS) for treating brainstem cavernous malformations (BSCMs).
- To assess the association of treatment modalities with recurrent hemorrhage and neurological outcomes in BSCM patients.
Main Methods:
- Retrospective cohort study utilizing an observational registry database from China (March 2011-March 2023).
- Propensity score matching was used to compare outcomes between microsurgery and SRS in adult BSCM patients.
- Outcomes included recurrent hemorrhage and poor prognosis (Glasgow Outcome Scale <4); Cox models were used for analysis.
Main Results:
- Among 96 matched patients (48 pairs), microsurgery and SRS demonstrated comparable rates of recurrent hemorrhage and poor prognosis after a median 5-year follow-up.
- Both microsurgery and SRS were associated with significantly fewer recurrent hemorrhages compared to conservative treatment.
- Hazard ratios for recurrent hemorrhage: Microsurgery vs. SRS (HR, 3.90; P=0.21); Microsurgery vs. Conservative (HR, 0.09; P=0.001); SRS vs. Conservative (HR, 0.21; P=0.01).
Conclusions:
- Microsurgery and SRS are safe and effective treatment options for brainstem cavernous malformations (BSCMs), yielding comparable outcomes.
- Both interventions significantly reduce the risk of recurrent hemorrhage compared to conservative management.
- Potential residual confounding necessitates cautious interpretation of the findings.
