Functional impact of multiple bleeding events in patients with conservatively treated spinal cavernous malformations

Laurèl RauschenbachDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Alejandro N. SantosDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Hanah H. GullDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Christoph RießDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Cornelius DeuschlInstitute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen;

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Börge SchmidtInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen; and

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Marvin Darkwah OppongDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Oliver GembruchDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Neriman ÖzkanDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Ramazan JabbarliDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Karsten H. WredeDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Ulrich SureDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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Philipp DammannDepartment of Neurosurgery and Spine Surgery, University Hospital Essen;
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Germany

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OBJECTIVE

The aim of this study was to investigate the functional outcome in spinal cavernous malformation (SCM) patients with single or multiple intramedullary hemorrhagic events.

METHODS

SCM patients who were conservatively treated between 2003 and 2021 and had complete clinical baseline characteristics, an MRI data set, at least one SCM-related intramedullary hemorrhage (IMH), and at least one follow-up examination were included in this study. Functional status was assessed using the modified McCormick Scale score at diagnosis, before and after each bleeding event, and at the last follow-up.

RESULTS

A total of 45 patients were analyzed. Univariate analysis identified multiple bleeding events as the only statistically significant predictor for an unfavorable functional outcome at the last follow-up (OR 15.28, 95% CI 3.22–72.47; p < 0.001). Patients significantly deteriorated after the first hemorrhage (29.0%, p = 0.006) and even more so after the second hemorrhage (84.6%, p = 0.002). Multiple bleeding events were significantly associated with functional deterioration at the last follow-up (76.9%, p = 0.003). The time between the last IMH and the last follow-up did not influence this outcome.

CONCLUSIONS

IMH due to SCM is linked to functional worsening. Such outcomes tend to improve after each hemorrhage, but the probability of full recovery declines with each bleeding event.

ABBREVIATIONS

CCM = cerebral cavernous malformation; ICH = intracerebral hemorrhage; IMH = intramedullary hemorrhage; SCM = spinal cavernous malformation.
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