Abstract
Background: Clinical management of patients with brainstem cavernous malformations (BSCM) is often challenging due to the unpredictable clinical course and lack of high-quality evidence. Nevertheless, radiologic follow-up is often performed routinely. The objective of this work was to investigate whether active follow-up by serial imaging is justified and how planned imaging will impact clinical decision making in absence of clinical progression.Methods: We included all consecutive patients with BSCM treated and followed at our Department between 2006 and 2018.Results: Of 429 patients with CCM, 118 were diagnosed with BSCM (27.5%). Patients were followed for a mean of 8.1 (± 7.4 SD) years. Conservative treatment was recommended in 54 patients over the complete follow-up period, whereas 64 patients underwent surgical extirpation of BSCM. In total, 75 surgical procedures were performed. Over a period of 961 follow-up years in total, routinely performed follow-up MRI in clinically stable patients did not lead to a single indication for surgery.Conclusion: Due to the difficult-to-predict clinical course of patients with BSCM and the relatively high risk associated with surgery, routine imaging is unlikely to have any influence on surgical decision making in clinically stable patients with BSCM.
Highlights
Cerebral cavernous malformations (CCM) are among the most common vascular lesions of the central nervous system (CNS)
Given the lack of literature on follow-up strategies for patients with brainstem cavernous malformations (BSCM) [8], the objective of this study was to critically address whether serial follow-up imaging in clinically stable patients with BSCM is justified and how frequently imaging will influence clinical decision making in these cases
Among the 64 patients that had undergone surgery, in 62 patients (96.8%) indication for surgical extirpation of the BSCM was done based on no-routine imaging that was performed in the context of clinical worsening as a direct consequence of BSCM hemorrhage
Summary
Cerebral cavernous malformations (CCM) are among the most common vascular lesions of the central nervous system (CNS). The clinical management of brainstem cavernous malformations (BSCM) poses a particular challenge. Given the highly eloquent anatomy with high density of cranial nerve nuclei and fiber tracts within the brainstem, even small BSCM hemorrhages can cause severe neurological symptoms. BSCM are associated with an increased risk of hemorrhage compared to CCM in other locations [1,2,3]. It is unknown whether this is due to the fact that CCM hemorrhages that cause significant symptomatology in the brainstem would go unnoticed in an ineloquent. Clinical management of patients with brainstem cavernous malformations (BSCM) is often challenging due to the unpredictable clinical course and lack of high-quality evidence. The objective of this work was to investigate whether active follow-up by serial imaging is justified and how planned imaging will impact clinical decision making in absence of clinical progression
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
