Natural History of Brainstem Cavernous Malformations: A Systematic Review and Meta-analysis

Objective: This systematic review and meta-analysis aims to synthesize the available evidence on the natural history, hemorrhage rates, risk factors, and clinical outcomes of BSCMs to guide clinical decision-making.

Methods: A literature search was performed in PubMed, Scopus, and Medline. Studies reporting on the natural history and clinical outcomes of BSCMs were included. Data on patient demographics, hemorrhage rates, risk factors, and outcomes were extracted and analyzed.

Results: A total of 156 studies involving 5,059 patients with BSCMs were included. The annual hemorrhage rate was 4.27% per patient-year, with a rehemorrhage rate of 31.06% per year. Significant risk factors for hemorrhage included larger lesion size (≥ 10 mm), associated developmental venous anomaly, and prior hemorrhage. At diagnosis, 27% of patients presented with motor deficits, 45% with cranial nerve palsies, and 0.017% with respiratory dysfunction. Surgical intervention was performed in 73.04% of cases, with 67.56% of patients achieving a favorable outcome (modified Rankin scale score ≤ 2). However, early postoperative morbidity and mortality rates remained significant at 27.2%.

Conclusion: BSCMs carry a substantial risk of hemorrhage and neurological morbidity. The natural history and risk factors identified in this meta-analysis can guide clinical decision-making and patient counseling. Further prospective studies are needed to refine risk stratification and management strategies for BSCMs.

Population demographics for surgical resection of BSCM
Parameter	Outcome
Number of patients	5,059
Age	36.6 ± 11.34
Male:Female ratio	0.861
Mean number of preoperative hemorrhages	1.89
Hemorrhage rate	4.27%
Re-hemorrhage rate	31.06%
Time from hemorrhage to surgery (days)	134.5
Duration of symptoms (weeks)	55.82
Motor deficits	1,366 (27%)
Cranial nerve palsy	2,284 (45%)
Respiratory dysfunction	85 (0.017%)

Outcome data for brainstem BSCM
Parameter	Outcome
GTR (%)	73.04
Follow-up (weeks)	133.81
Average mRS (preoperative)	2.44
Average mRS (postoperative)	2.20
Average mRS (last follow-up)	1.67
Postoperative rebleed (%)	17.12%
Percent improved (mRS < 2)	67.56%
Percent worse (mRS >2)	10.23%
Death (%)	1.39%
Early morbidity and mortality (%)	27.2%

Complications associated with removal of brainstem BSCM
Complication	Frequency [N (%)]
CN palsy	488 (30.14)
Infection	127 (7.84)
Tracheostomy	131 (8.09)
Hemiparesis	103 (6.36)
Dysphagia	121 (7.47)
CSF leak	83 (5.13)
PEG	81 (5.00)
Hemihypesthesia	56 (3.46)
Hydrocephalus	56 (3.46)

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025