Kantonsspital St.Gallen
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Natural history of brainstem cavernous malformations: on the variation in hemorrhage rates

Yang Yang, Julia Velz, Marian C Neidert, Martin N. Stienen, Luca Regli & Oliver Bozinov

abstract

BACKGROUND
Hemorrhage rates of conservatively managed brainstem cavernous malformations (BSCMs) vary widely in the literature. We aimed to elucidate the reason for the variation and to add the results of our experience of BSCMs management over the past decade.

METHODS
We performed a review of consecutive patients with BSCMs referred to our department in the period 2006-2018. A hemorrhagic event was defined as a radiographically verified intralesional and extralesional hemorrhage. Both retrospective and prospective hemorrhage rates were calculated based on the patient age in years, counted either from birth or from the time of initial presentation until the last contact (or until surgical resection). In addition, we retrieved and reviewed publications with a clear definition of hemorrhagic event and a detailed description of BSCM hemorrhage rate.

RESULTS
In total, 118 patients with BSCMs were reviewed, and 78 patients (mean age on admission 45.9 years) were included in the final analysis. The retrospective and prospective hemorrhage rates were 1.9% (95% confidence interval (CI):1.6-2.3%) per year and 11.9% (95% CI: 7.5-17.8%), respectively. The retrospective hemorrhage rate in the literature review ranged from 1.9- 6.8% per year with a median value of 3.8%, while the prospective hemorrhage rate ranged between 4.1-21.5% with a median value of 10.2%.

CONCLUSION
The reported hemorrhage rates are calculated in two different ways. In our patient cohort, both the retrospective and prospective hemorrhage rates were in accordance with those in the literature. The long-term hemorrhage rate lies between the prospective and retrospective rate.
   
citation Yang Y, Velz J, Neidert M C, Stienen M N, Regli L, Bozinov O. Natural history of brainstem cavernous malformations: on the variation in hemorrhage rates. World Neurosurg 2021;.
   
type journal paper/review (English)
date of publishing 14-10-2021
journal title World Neurosurg
ISSN electronic 1878-8769
PubMed 34656794
DOI 10.1016/j.wneu.2021.10.092