Resident University of Miami Miami, Florida, United States
Introduction: Surgical resection of brainstem cavernous malformations (BSCMs) can be associated with significant morbidity. There is considerable variability among identified prognostic factors for long-term functional outcomes. This study evaluates predictors of long-term outcomes following surgical resection of BSCMs.
Methods: We retrospectively reviewed patients who underwent surgical treatment of BSCMs between April 1998 to March 2022. Clinical characteristics, complications, and outcomes were examined. Modified Rankin Scale (mRS) was evaluated at admission, discharge, and final follow-up and dichotomized into favorable (mRS≤2) or unfavorable (mRS>2). Univariate and multivariate analysis were used to evaluate predictors. P≤0.05 and odds ratio with 95% confidence interval were considered significant. Statistical analyses conducted with PRISM.
Results: 45patients(48.9% male), mean age 44years underwent surgical resection. Gross total resection was 90%. Mean follow-up was 50.5months. 26.7% had worse mRS at discharge but only 7.3% remained worse at final follow-up. 87.8% had favorable mRS at final follow-up. Univariate analysis identified preoperative cancer diagnosis(P=0.012), need for preoperative CSF diversion(P=0.002), irregular shape(P=0.017), hospitalization time(P=0.013), having postoperative medical complications(P=0.017) or stroke(P=0.012), higher mRS at discharge(P=0.002), and worse mRS at discharge(P=0.014) as predictors of poor long-term outcomes. Need for preoperative CSF diversion and mRS at discharge were the strongest predictors but only preoperative CSF diversion was an independent predictor on multivariate analysis(P=0.021).
Conclusion : Preoperative cancer diagnosis, need for preoperative CSF diversion, irregular shape, hospitalization time, having postoperative medical complications or stroke, higher or worse mRS at discharge were predictors of unfavorable long-term outcomes. Though poor mRS at discharge is the most tangible factor with the greatest impact on patients and families, it is only one of many predictors. The most important predictor is need for preoperative CSF diversion. Furthermore, patients can be counseled that surgery can create symptoms mimicking a prior bleed and worsen mRS at discharge but they are likely to improve at follow-up.
