Surgical treatment of brainstem cavernous malformations: an international Delphi consensus

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  • 1 Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany;
  • | 2 UAM Chair “Innovation in Neurosurgery,” Universidad Autónoma de Madrid, Spain;
  • | 3 Columbia University Medical Center Department of Neurological Surgery, New York, New York;
  • | 4 Department of Neurosurgery, Turku University Hospital, Turku, Finland;
  • | 5 Department of Neurosurgery, Juha Hernesniemi International Center, Henan Provincial People’s Hospital, University of Zhengzhou, China;
  • | 6 Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona;
  • | 7 Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California;
  • | 8 Department of Neurological Surgery, University of California, San Francisco, Fresno Campus, Fresno, California;
  • | 9 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 10 Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
  • | 11 Neurosurgery, Mayo Clinic, Rochester, Minnesota;
  • | 12 Department of Neurological Surgery, University of Miami, Florida;
  • | 13 Department of Neurosurgery and Neuro-oncology, Military University Hospital and Charles University, First Medical Faculty, Prague, Czech Republic;
  • | 14 Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom;
  • | 15 Department of Neurosurgery, University of Utah, Salt Lake City, Utah;
  • | 16 Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany;
  • | 17 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;
  • | 18 Department of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland;
  • | 19 Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany; and
  • | 20 Department of Neurosurgery, Niguarda Metropolitan Hospital, Milan, Italy
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OBJECTIVE

Indication for surgery in brainstem cavernous malformations (BSCMs) is based on many case series, few comparative studies, and no randomized controlled trials. The objective of this study was to seek consensus about surgical management aspects of BSCM.

METHODS

A total of 29 experts were invited to participate in a multistep Delphi consensus process on the surgical treatment of BSCM.

RESULTS

Twenty-two (76%) of 29 experts participated in the consensus. Qualitative analysis (content analysis) of an initial open-ended question survey resulted in 99 statements regarding surgical treatment of BSCM. By using a multistep survey with 100% participation in each round, consensus was reached on 52 (53%) of 99 statements. These were grouped into 4 categories: 1) definitions and reporting standards (7/14, 50%); 2) general and patient-related aspects (11/16, 69%); 3) anatomical-, timing of surgery–, and BSCM-related aspects (22/37, 59%); and 4) clinical situation–based decision-making (12/32, 38%). Among other things, a consensus was reached for surgical timing, handling of associated developmental venous anomalies, handling of postoperative BSCM remnants, assessment of specific anatomical BSCM localizations, and treatment decisions in typical clinical BSCM scenarios.

CONCLUSIONS

A summary of typical clinical scenarios and a catalog of various BSCM- and patient-related aspects that influence the surgical treatment decision have been defined, rated, and interpreted.

ABBREVIATIONS

BSCM = brainstem cavernous malformation; CCM = cerebral cavernous malformation; DVA = developmental venous anomaly; SH = symptomatic hemorrhage.

Supplementary Materials

    • Supplemental Digital Content 1-5 (PDF 548 KB)

Illustration from Serrato-Avila (pp 1410–1423). Copyright Johns Hopkins University, Art as Applied to Medicine. Published with permission.

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