Multimodal outcome assessment after surgery for brainstem cavernous malformations

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  • 1 Department of Neurosurgery, University Hospital Essen;
  • 2 Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen;
  • 3 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen; and
  • 4 Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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OBJECTIVE

The object of this study was to assess outcome after surgery for brainstem cavernous malformations (BSCMs) using functional, health-related quality of life (HRQOL), and psychological surveys to analyze the interrelation of these measurements, and to compare HRQOL and anxiety and depression scores with those in a healthy population.

METHODS

The authors performed a cross-sectional outcome study of all patients surgically treated for BSCM in their department between January 1, 2003, and December 31, 2019. They assessed functional outcome via the modified Rankin Scale (mRS), health-related quality of life (HRQOL) via the SF-36 and 9-item Life Satisfaction Questionnaire (LISAT-9), cranial nerve and brainstem function using a questionnaire, symptom-based psychological outcome via the Hospital Anxiety and Depression Scale (HADS), and timepoint of a return to previous employment. They analyzed the correlation between absolute (mRS score ≤ 2) and relative (postoperative deterioration in initial mRS score) outcome endpoints and the interrelation of the outcome measures and performed a comparison of HRQOL and HADS scores with findings in a healthy population.

RESULTS

Seventy-four patients were eligible for inclusion in the study. HRQOL was impaired after surgery for BSCM compared to that in a healthy population. This impairment was substantial in patients with an unfavorable functional outcome (mRS > 2) but was also present in those with a favorable outcome (mRS ≤ 2) in selected domains. Psychological impairment was negligible in patients with a favorable outcome and grave in those with an unfavorable outcome. LISAT-9 results revealed that brainstem and cranial nerve symptoms reduce satisfaction mainly in self-care abilities for both unfavorable and favorable outcome patients. Among the brainstem and cranial nerve symptoms, balance impairment showed the most significant impact on HRQOL. Absolute outcome endpoints were superior to relative outcome endpoints in reflecting impairment in HRQOL after surgery.

CONCLUSIONS

The study data can improve patient counseling and decision-making in BSCM treatment and may function as a benchmark. The authors report outcomes after BSCM surgery in high detail, emphasizing the specific impact of cranial nerve and brainstem symptoms on HRQOL. When reporting BSCM surgery outcome, absolute outcome endpoints should be applied.

ABBREVIATIONS AUC = area under the curve; BSCM = brainstem cavernous malformation; CCM = cerebral cavernous malformation; HADS = Hospital Anxiety and Depression Scale; HADS-A = Anxiety Subscale of HADS; HADS-D = Depression Subscale of HADS; HRQOL = health-related quality of life; LISAT-9 = 9-item Life Satisfaction Questionnaire; MCS = mental component summary of SF-36; mRS = modified Rankin Scale; PCS = physical component summary of SF-36; ROC = receiver operating characteristic.

Supplementary Materials

    • Supplemental Tables and Figure (PDF 460 KB)

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Contributor Notes

Correspondence Philipp Dammann: University Hospital Essen, Germany. philipp.dammann@uk-essen.de.

INCLUDE WHEN CITING Published online October 16, 2020; DOI: 10.3171/2020.6.JNS201823.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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