Surgical timing and approach for brainstem cavernous malformation warranting thorough preoperative evaluation

Area of Science:

• Neurosurgery
• Neurology
• Vascular Malformations

Background:

• Hemorrhage from brainstem cavernous malformations (BSCMs) can lead to significant neurological deficits.
• While surgical intervention for BSCMs is established, the ideal timing post-hemorrhage is not well-defined.
• Understanding optimal surgical timing is crucial for maximizing patient recovery and functional outcomes.

Purpose of the Study:

• To determine the optimal timing for surgical intervention following hemorrhage in patients with brainstem cavernous malformations.
• To analyze the relationship between surgical timing and patient outcomes using the modified Rankin Scale (mRS).

Main Methods:

• Retrospective analysis of 135 patients who underwent surgery for BSCMs between 2012 and 2022.
• Patients were stratified into four surgical timing groups: hyperacute (≤7 days), acute (8-20 days), subacute (21-56 days), and chronic (>56 days).
• Outcomes were assessed using the best post-treatment mRS scores, comparing clinical characteristics and prognosis across timing groups.

Main Results:

• A total of 135 patients were included, with the majority of lesions in the pons.
• Favorable outcomes (based on mRS) were observed in 113 patients.
• Significant differences in mRS scores were found between surgical timing groups, with better outcomes in the acute and subacute phases compared to hyperacute and chronic phases.

Conclusions:

• Surgical intervention for brainstem cavernous malformations during the acute (8-20 days) and subacute (21-56 days) phases post-hemorrhage is associated with improved neurological function.
• These findings suggest that delaying surgery beyond the subacute phase may negatively impact recovery.
• Optimizing surgical timing is a key factor in improving patient prognosis after BSCM hemorrhage.