Materiały źródłowe

• #1 Complications of the Surgery for Cavernomas | Neupsy Key

  https://neupsykey.com/complications-of-the-surgery-for-cavernomas/

  Cavernomas may arise everywhere in the Central Nervous System. These benign vascular lesions can be really harmful for the patient provoking death or severe neurological disability. […] The natural course of cavernous malformations is rather unpredictable. […] The risk for hemorrhage is estimated between 0.6% and 5% (annual rate). Among those who bleed, 30% will rebleed over time. […] This is considered the major indication for surgery because the severity of the clinical deficit would increase over time due to further episodes of hemorrhage. […] The recommendation for surgery is influenced by the estimated risk of future bleeding (that is, the natural history of the lesion), the neurologic injury predicted to occur with such a hemorrhage, and the patients clinical situation with special attention to neurologic condition, age, and the size and location of the lesion.

• #1 Cavernous Malformation (Cavernoma): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21594-cavernous-hemangioma

  Cerebral cavernous malformation bleeds and ruptures aren’t common, but they do happen. Research estimates that you have a 2.4% chance of having a bleed annually if you have one. […] Treatment options are available. While there are risks to surgery, the outcome of removing a cerebral cavernous malformation is usually successful if your surgeon can safely access it. […] Yes, if you had a bleed, you’re at a higher risk of a future bleed. A healthcare provider will let you know how to take care of yourself to help prevent future bleeds. […] Cerebral cavernous malformations can be life-threatening if they cause severe bleeding. But most don’t affect life expectancy. Complications after a bleed, however, may affect your quality of life, like after a stroke. […] Each person’s situation is different. You should speak with your healthcare provider to learn more about your situation.

• #1 Natural course of cerebral and spinal cavernous malformations: a complete ten-year follow-up study | Scientific Reports

  https://www.nature.com/articles/s41598-023-42594-0

  Knowledge of the bleeding risk and the long-term outcome of conservatively treated patients with cavernous malformations (CM) is poor. […] Adjusted multivariate logistic regression analysis identified bleeding at diagnosis (p=0.039) and CM localization to the spine (p=0.010) as predictors for (re)hemorrhage. […] The cumulative 10-year risk of bleeding was 30% for the whole cohort, 39% for patients with bleeding at diagnosis and 67% for ISCM. […] During an untreated 10-year follow-up, the probability of hemorrhage increased over time, especially in cases with bleeding at presentation and spinal cord localization. […] Our results suggest a more aggressive course in patients with ISCM, although the small number of cases significantly limits the robustness of the analyses.

• #1 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8717781/

  Haemorrhages of brainstem cavernous malformations (CMs) can lead to neurological deficits, the natural history of which is uncertain. The study aimed to evaluate the neurological outcomes of untreated brainstem CMs and to identify the adverse factors associated with worsened outcomes. […] After a median follow-up of 60.9 months, prospective haemorrhages occurred in 167 patients (23.9%). The mean modified Rankin Scale scores at enrolment and at censoring time were 1.6 and 1.2. Neurological status was improved, unchanged and worsened in 334 (47.9%), 293 (42.0%) and 71 (10.2%) patients, respectively; 233 (33.4%) recovered to normal levels. […] The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. Radiological features significantly predicted worsened outcomes. Our results provide evidence for clinical consultation and individualised treatment.

• #1 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8717781/

  The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if 1 ictus)). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

• #1 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review | Stroke and Vascular Neurology

  https://svn.bmj.com/content/6/4/501

  The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. […] Radiological features significantly predicted worsened outcomes. […] The percentage of worsened outcomes was 5.3% (18 of 337) in low-risk patients (neither DVA nor crossing the axial point) and increased to 26.0% (13 of 50) in high-risk patients (with both DVA and crossing the axial point). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). […] In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

• #1 Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8827309/

  The aim of this study is to analyze the long-term quality of life after surgery of cavernoma. […] Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. […] After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. […] At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. […] These results add value for decision-making as well as patient counseling for future encountered cases. […] The main concern is the outcome of surgical treatment. […] The results in the presented study were comparable to the outcome stated in the literature. […] The fear of surgical morbidity should be reconsidered when we look at the prolonged follow-up of the patients, where the neurological deficits will mostly recover and the risk of hemorrhage from the cavernoma will decrease or even be eliminated by the complete resection.

• #1

  https://link.springer.com/article/10.1007/s10143-021-01572-8

  The aim of this study is to analyze the long-term quality of life after surgery of cavernoma. […] Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. […] After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. […] Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. […] At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. […] The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. […] These results add value for decision-making as well as patient counseling for future encountered cases.

• #1

  https://link.springer.com/article/10.1007/s10143-021-01572-8

  An unfavorable outcome (mRS2) was seen in 12.2% of patients in EG and 0% in NEG at the last follow-up. […] The change of mRS throughout the course of the disease is illustrated in (Fig. 3). […] The assessment of QoL with the SF12 questionnaire was performed during the last follow-up. […] The results in the presented study were comparable to the outcome stated in the literature. […] The fear of surgical morbidity should be reconsidered when we look at the prolonged follow-up of the patients, where the neurological deficits will mostly recover and the risk of hemorrhage from the cavernoma will decrease or even be eliminated by the complete resection. […] To summarize the results about the QoL, we found that patients with cavernoma located in eloquent regions after surgery mostly had a non-inferior QoL compared to NEG except the physical role (RP) domain.

• #1 Long-term outcomes after surgery for brainstem cavernous malformations: analysis of 46 consecutive cases in: Journal of Neurosurgery Volume 138 Issue 4 (2022) Journals

  https://thejns.org/view/journals/j-neurosurg/138/4/article-p900.xml

  Long-term outcomes after resection of brainstem cavernous malformations (BSCMs) were evaluated retrospectively in 46 consecutive cases. […] The objective of this study was to evaluate the long-term outcomes after resection of brainstem cavernous malformations (BSCMs) and to assess the usefulness of the Lawton grading system in these cases. […] In total, 24 BSCMs (52%) had bilateral extension crossing the brainstem midline. […] Total resection of BSCMs was attained in 43 patients (93%). […] The majority of patients demonstrated good functional recovery, but regress of the preexisting oculomotor nerve deficit was usually incomplete. […] In 42 patients (91%), the mRS score at the time of last follow-up was ≤ 2 (favorable outcome), and in 18 (39%), it was 0 (absence of neurological symptoms).

• #1 Long-term outcomes after surgery for brainstem cavernous malformations: analysis of 46 consecutive cases in: Journal of Neurosurgery Volume 138 Issue 4 (2022) Journals

  https://thejns.org/view/journals/j-neurosurg/138/4/article-p900.xml

  Multivariate analysis revealed that only lower Lawton grade had a statistically significant independent association (p = 0.0280) with favorable long-term outcome. […] The area under the receiver operating characteristic curve for prediction of favorable outcome with 7 available Lawton grades of BSCM was 0.93. […] Resection of hemorrhagic BSCMs by an experienced neurosurgeon may be performed safely and effectively, even in severely disabled patients. […] The Lawton grading system effectively predicts long-term outcome after surgery.

• #1

  https://link.springer.com/article/10.1007/s00701-022-05354-z

  The relative risk for a new neurological deficit at 1-year follow-up, when reversible IONM-deterioration was registered compared to irreversible IONM deterioration, was 0.56 (0.231.37) for MEP deterioration and 0.4 (0.180.89) for SSEP deterioration. […] A reversible IONM change was associated with a reduced risk of a permanent neurological deterioration at 1-year follow-up compared to an irreversible IONM change (for MEP and SSEP 17 vs 30% and 25 vs 62.5%, respectively). […] The relationship between reversible IONM changes and a more favorable prognosis with regard to neurological outcome alludes to the importance of IONM and the evaluation of this relationship in SCCM surgery is a major importance of our study compared to other SCCM case series.

• #1 Functional outcome after pediatric cerebral cavernous malformation surgery | Scientific Reports

  https://www.nature.com/articles/s41598-023-29472-5

  The purpose of this study was to investigate the functional outcome following surgical resection of cerebral cavernous malformations (CCM) in pediatric patients. […] The primary endpoint was the postoperative functional outcome. As a secondary endpoint, predictors of postoperative functional deterioration were assessed. […] 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. […] Our analysis, adjusted to age and sex, identified brainstem localization as a predictor for postoperative deterioration, while non-brainstem localization was not associated with worse outcomes.

• #1 Assessing the Relationship between Surgical Timing and Postoperative Seizure Outcomes in Cavernoma-Related Epilepsy: A Single-Institution Retrospective Analysis of 63 Patients with a Review of the Literature

  https://www.mdpi.com/2076-3425/14/5/494

  Patients with CRE who underwent early surgery achieved or sustained higher rates of ILAE class 1 seizure freedom and AED independence than patients who underwent delayed surgery. […] Early CRE surgery demonstrated better seizure outcomes than delayed surgery. […] A longer duration of CRE before surgery has been associated with unfavorable postoperative seizure outcomes and AED dependency. […] Surgery should be considered in patients presenting with a single seizure as a preventative measure given that up to 94% of patients have a recurrent seizure within 5 years. […] Our results suggest that patients with CRE may benefit more from early surgery and have more favorable long-term outcomes than patients who undergo delayed surgery.

• #1 The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery: A Systematic Review and Meta-Analysis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136619

  Seizure outcome was significantly improved in the patients who underwent an extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.420.91; P = 0.01). […] Patients who underwent extended surrounding hemosiderin excision could exhibit significantly improved seizure outcomes compared to patients without hemosiderin excision. […] The results of this paper show that seizure outcome was statistically significantly improved in patients who underwent an extended excision of the surrounding hemosiderin. […] This meta-analysis compared hemosiderin excision and hemosiderin reservation groups in CCM surgery and demonstrated that seizure outcome could be significantly improved in patients who undergo extended excision of the surrounding hemosiderin.

• #1 Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8827309/

  To summarize the results about the QoL, we found that patients with cavernoma located in eloquent regions after surgery mostly had a non-inferior QoL compared to NEG except the physical role (RP) domain. […] Our results in line with the results of the previous studies show that the QoL accompanied by the neurological outcome is an essential and powerful element to support the decision for treating CNS cavernomas, especially if the cavernoma is in an eloquent area. […] At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG (85.4% of patients). […] Regarding QoL, patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role RP) compared to NEG. […] These results of how these patients are doing years after surgery could improve the decision-making as well as the patient counseling for future encountered cases of cavernomas in eloquent and non-eloquent regions. […] For future studies, preoperative QoL measurements for the assessment of QoL dynamics are highly recommended.

• #1 Cavernous hemangioma – Wikipedia

  https://en.wikipedia.org/wiki/Cavernous_hemangioma

  A few studies have worked on providing details related to the outlook of disease progression. […] Two studies show that each year 0.5% of people who had never had bleeding from their brain cavernoma, but had symptoms of seizures, were affected by bleeding. […] In contrast, patients who have had bleeding from their brain cavernoma in the past had a higher risk of being affected by subsequent bleeding. […] However, when cavernous hemangiomas are completely excised, there is very little risk of growth or rebleeding. […] Not enough data has been collected on life expectancy of patients with this malformation to provide a representative statistical analysis.

• #1 Complications of the Surgery for Cavernomas | Neupsy Key

  https://neupsykey.com/complications-of-the-surgery-for-cavernomas/

  Another important parameter is the location of the cavernoma. Cavernomas in eloquent areas are poorer candidates. […] Another important consideration for surgery is epilepsy. […] Surgical removal should not be encouraged for older patients with very late bleeding. Early bleeding and younger patients would lead toward a more aggressive attitude because outcome is linked to the rate of further episodes of rebleeding. […] Timing for cavernoma surgery is a very important aspect of the management of these malformations. […] In summary, the timing for surgery is a factor to be taken into account to avoid postoperative morbidity. […] Recurrence of bleeding after initial surgery is directly related to incomplete previous resection. […] Although the global rate of rebleeding in cavernoma surgery is considered very low (less than 1%), when a remnant is left in the surgical field, there is a high probability for rebleeding: 62% of residual lesions will bleed.

• #2 Natural course of cerebral and spinal cavernous malformations: a complete ten-year follow-up study | Scientific Reports

  https://www.nature.com/articles/s41598-023-42594-0

  Knowledge of the bleeding risk and the long-term outcome of conservatively treated patients with cavernous malformations (CM) is poor. […] Adjusted multivariate logistic regression analysis identified bleeding at diagnosis (p=0.039) and CM localization to the spine (p=0.010) as predictors for (re)hemorrhage. […] The cumulative 10-year risk of bleeding was 30% for the whole cohort, 39% for patients with bleeding at diagnosis and 67% for ISCM. […] During an untreated 10-year follow-up, the probability of hemorrhage increased over time, especially in cases with bleeding at presentation and spinal cord localization. […] Our results suggest a more aggressive course in patients with ISCM, although the small number of cases significantly limits the robustness of the analyses.

• #2 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review | Stroke and Vascular Neurology

  https://svn.bmj.com/content/6/4/501

  The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. […] Radiological features significantly predicted worsened outcomes. […] The percentage of worsened outcomes was 5.3% (18 of 337) in low-risk patients (neither DVA nor crossing the axial point) and increased to 26.0% (13 of 50) in high-risk patients (with both DVA and crossing the axial point). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). […] In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

• #2

  https://link.springer.com/article/10.1007/s10143-021-01572-8

  The aim of this study is to analyze the long-term quality of life after surgery of cavernoma. […] Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. […] After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. […] Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. […] At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. […] The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. […] These results add value for decision-making as well as patient counseling for future encountered cases.

• #2 Functional outcome after pediatric cerebral cavernous malformation surgery | Scientific Reports

  https://www.nature.com/articles/s41598-023-29472-5

  Logistic regression analysis adjusted for age and sex identified brainstem localization (aOR=53.45 [95%CI=2.261261.81], p=.014) as statistically significant predictor for postoperative deterioration. […] Our study confirms the safety and feasibility of surgical CCM removal in pediatric patients. Lesion location should mitigate decisions towards or against surgery. Little evidence does indicate that second-look surgery for CCM remnants might be safe and valuable, but more detailed studies are needed to confirm this assumption.

• #2

  https://link.springer.com/article/10.1007/s10143-021-01572-8

  Our results in line with the results of the previous studies show that the QoL accompanied by the neurological outcome is an essential and powerful element to support the decision for treating CNS cavernomas, especially if the cavernoma is in an eloquent area. […] For future studies, preoperative QoL measurements for the assessment of QoL dynamics are highly recommended.

• #2 Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8827309/

  The aim of this study is to analyze the long-term quality of life after surgery of cavernoma. […] Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. […] After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. […] At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. […] These results add value for decision-making as well as patient counseling for future encountered cases. […] The main concern is the outcome of surgical treatment. […] The results in the presented study were comparable to the outcome stated in the literature. […] The fear of surgical morbidity should be reconsidered when we look at the prolonged follow-up of the patients, where the neurological deficits will mostly recover and the risk of hemorrhage from the cavernoma will decrease or even be eliminated by the complete resection.

Zobacz więcej