Search Results

You are looking at 1 - 7 of 7 items for :

  • "brainstem CCM" x
Clear All
Restricted access

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

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Free access

Michael T. Lawton and Michael J. Lang

brain aneurysms ( E ) and cumulative number of open microsurgical procedures for CCMs, brain AVMs, and bypasses ( F ). Expanding Open Microsurgery: Brainstem Cavernous Malformations From Inoperable to Operable Not long ago, neurosurgeons believed the brainstem was a surgical no-man’s-land where densely packed cranial nerve nuclei and ascending and descending neural tracts prevented operative transgression. Walter Dandy is credited with the first accurate diagnosis and successful removal of a brainstem CCM in 1934, but few cases were documented in the following decades

Full access

M. Yashar S. Kalani, Michael T. Lawton and Robert F. Spetzler

after the initial hemorrhage. Based on a recent large meta-analysis, the estimated 5-year risk of hemorrhage in patients with brainstem CCM presenting with ICH or FND was 30.8%, whereas that for brainstem CCMs without ICH or FND was 8.0%. Therefore, the rate of hemorrhage based on this meta-analysis on a per-year basis is between 1.6% and 6.1%. Nagy et al. cited a lifetime annual hemorrhage rate of 2.4% per lesion for patients with a single hemorrhage. The rate appears to stabilize at 1.1% after an initial increase to 4.3% during the first 2 years after radiosurgery

Restricted access

L. Dade Lunsford, Aftab A. Khan, Ajay Niranjan, Hideyuki Kano, John C. Flickinger and Douglas Kondziolka

Samii et al. 34 have even suggested early surgical removal of previously unruptured brainstem CCMs. Surprisingly the role of SRS has remained controversial despite our and others' seemingly judicious recommendation that SRS should be reserved for high-surgical-risk CCMs that bleed repeatedly. 10 , 15 , 21 In the present study we evaluated the outcomes of radiosurgery for solitary CCMs in an expanded series of 103 patients with a further extension of follow-up. We used follow-up MR imaging and clinical assessment to calculate the hemorrhage rate before and after

Full access

Sean M. Lew

genetic testing. F ig . 2. Case 2. Left: Axial noncontrast CT scan demonstrating a hemorrhagic posterior fossa mass with obstructive hydrocephalus and brainstem compression. Right: Postoperative sagittal T1-weighted noncontrast MR image revealing a residual brainstem CCM. On arrival, the patient was taken immediately to surgery. A right frontal external ventricular drain was placed, and markedly elevated intraventricular pressure was demonstrated. A posterior fossa craniotomy was then performed, which revealed a large cavernous malformation involving the

Restricted access

Yuan Zhu, Christian Peters, Monika Hallier-Neelsen, Dorothea Miller, Axel Pagenstecher, Helmut Bertalanffy and Ulrich Sure

to a low number of samples. The patients included 23 women and 39 men with a mean age of 40 ± 14 years (range 18–65 years). The lesions were supratentorial in 27 patients and in the brainstem in 35. The most common presenting symptoms were seizures in patients with supratentorial lesions and focal neurological deficits in patients with brainstem CCMs. In most patients, at least 1 clinical episode of hemorrhage could be documented. Among 62 patients with CCMs, 3 suffered from familial CCMs. Fourteen patients with CCMs had multiple lesions and the other 48 had single

Full access

New Orleans, LA • April 29–May 2, 2018

. Dade Lunsford, MD Introduction: The role of stereotactic radiosurgery (SRS) for brainstem cerebral cavernous malformations (CCMs) has remained controversial. We evaluated clinical outcomes as a measure of treatment efficacy, as current radiographic modalities cannot detect CCM obliteration. Methods: Between 1988 and 2016 at the University of Pittsburgh, SRS was performed with the Gamma Knife in 76 evaluable patients with solitary symptomatic brainstem CCMs. Ninety-one percent of these patients had experienced 2 or more hemorrhages associated with new neurological