Prospective untreated outcomes in patients with cerebral cavernous malformation

Area of Science:

• Neurology
• Neurosurgery
• Medical Genetics

Background:

• Cerebral cavernous malformations (CCMs) are vascular anomalies that can lead to neurological deficits.
• Long-term outcomes and risk factors for disability in untreated CCM patients are not fully understood.

Purpose of the Study:

• To determine the long-term morbidity and disability risks associated with untreated cerebral cavernous malformations.
• To identify predictors of disability in patients with CCM.

Main Methods:

• Prospective cohort study of 332 patients with CCM.
• Functional outcome assessed using the modified Rankin Scale (mRS).
• Kaplan-Meier curves and Cox proportional hazards models used to analyze time to disability and risk factors.

Main Results:

• Most patients showed improvement in mRS scores within the first year post-hemorrhage.
• The 5-year and 10-year disability risk for brainstem CCMs was 18.8% and 35.4%, respectively, versus 4.1% and 7.5% for non-brainstem locations.
• Predictors of disability included brainstem location, history of psychiatric disorder, and two or more symptomatic hemorrhages (SHs).

Conclusions:

• Functional outcomes generally improve after the first symptomatic hemorrhage, particularly within the first year.
• Disability risk escalates with each subsequent symptomatic hemorrhage.
• Key factors predicting long-term disability include brainstem CCM location, multiple hemorrhages, and a history of psychiatric disorder.