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Alejandro N. Santos, Laurèl Rauschenbach, Marvin Darkwah Oppong, Bixia Chen, Annika Herten, Michael Forsting, Ulrich Sure and Philipp Dammann


Treatment indications for patients with brainstem cavernous malformations (BSCMs) remain difficult and controversial. Some authors have tried to establish classification tools to identify eligible candidates for surgery. Authors of this study aimed to validate the performance and replicability of two proposed BSCM grading systems, the Lawton-Garcia (LG) and the Dammann-Sure (DS) systems.


For this cross-sectional study, a database was screened for patients with BSCM treated surgically between 2003 and 2019 in the authors’ department. Complete clinical records, preoperative contrast-enhanced MRI, and a postoperative follow-up ≥ 6 months were mandatory for study inclusion. The modified Rankin Scale (mRS) score was determined to quantify neurological function and outcome. Three observers independently determined the LG and the DS score for each patient.


A total of 67 patients met selection criteria. Univariate and multivariate analyses identified multiple bleedings (p = 0.02, OR 5.59), lesion diameter (> 20 mm, p = 0.007, OR 5.43), and patient age (> 50 years, p = 0.019, OR 4.26) as predictors of an unfavorable postoperative functional outcome. Both the LG (AUC = 0.72, p = 0.01) and the DS (AUC = 0.78, p < 0.01) scores were robust tools to estimate patient outcome. Subgroup analyses confirmed this observation for both grading systems (LG: p = 0.005, OR 6; DS: p = 0.026, OR 4.5), but the combined use of the two scales enhanced the test performance significantly (p = 0.001, OR 22.5).


Currently available classification systems are appropriate tools to estimate the neurological outcome after BSCM surgery. Future studies are needed to design an advanced scoring system, incorporating items from the LG and the DS score systems.

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M. Yashar S. Kalani and Joseph M. Zabramski

pregnancy, 2% per patient-year) than in the familial group (3.6% per pregnancy, 4% per patient-year). The clinical histories of the 4 patients with symptomatic pregnancies are summarized in Table 2 . TABLE 2: Summary of symptomatic hemorrhage cases * Case No. Type of CCM Age at Symptom Onset (yrs) Pregnancy Age (yrs) Symptomatic Pregnancy Type of Delivery Type of Symptoms CCM Surgery/Age at Surgery (yrs) 1 S 25 27 yes V motor yes/40 30 no V 2 F 9 19 yes V seizures no

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Mitsuru Yagi, Ken Ninomiya, Michiya Kihara and Yukio Horiuchi

C ervical compression myelopathy is the most common acquired cause of myelopathy in the cervical spine. Although surgical intervention is generally indicated for patients with severe motor deficits, favorable outcomes. 6 Unfortunately, for some patients with CCM, surgery is not always effective. Various factors affecting the clinical outcome have been extensively investigated; in previous reports, duration of symptoms, age, and previous trauma have been studied as important factors. 2 , 11 , 13 , 18 , 20 , 21 , 23 , 33 Some studies also demonstrated CCM on

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Michael T. Lawton and Michael J. Lang

the local Hispanic patient population in whom CCMs were so prevalent, reinforced the breakthrough that microsurgery for brainstem CCMs was often safe and advisable. 47 This convergence of available cases and a master who practiced both high-level microsurgery and skull base surgery shaped a new discipline within vascular neurosurgery. Brainstem Microsurgery Brainstem CCM surgery began with simple concepts like the “two-point method” to select the best surgical approach. 8 Complex skull base exposures that had been developed for tumors and aneurysms were adapted to