Outcomes of surgically managed brainstem cavernous Malformations: A systematic review and Meta-Analysis

Abstract

Background: Brainstem cavernous malformations (BSCMs) are rare vascular lesions that can cause significant neurological deficits due to their critical location. This systematic review and meta-analysis aims to synthesize the available evidence on the hemorrhage rates, risk factors, and clinical outcomes of BSCMs to guide clinical decision-making.

Methods: A comprehensive literature search was performed in PubMed, Scopus, Medline for articles published from 1986 to June 2024. Studies reporting on the clinical outcomes of BSCMs were included. Data on patient demographics, hemorrhage rates, risk factors, and outcomes were extracted and analyzed using random-effects meta-analysis models.

Results: A total of 81 studies involving4046 patients with BSCMs were included. The annual hemorrhage rate was 4.67 % per patient-year, with a rehemorrhage rate of 34.44 % per year. At diagnosis, 31 % of patients presented with motor deficits, 51 % with cranial nerve palsies, and 2.05 % with respiratory dysfunction. Surgical intervention was performed in all cases, with 65.38 % of patients achieving a favorable outcome (modified Rankin Scale score ≤ 2). However, early postoperative morbidity and mortality rates remained significant at 11.53 %. A significant risk factor for increased rates of post-operative morbidity and mortality was male sex and rates of post-operative morbidity and mortality were found to significantly decrease from 1990 s till early 2020 s.

Conclusion: BSCMs carry a substantial risk of hemorrhage and neurological morbidity. While surgical intervention can provide favorable outcomes for selected patients, the risks and benefits must be carefully weighed on an individual basis as there is still considerable risk of post-operative hemorrhage. Further prospective studies are needed to refine risk stratification and management strategies for BSCMs.

Keywords: Brainstem cavernous malformations; Hemorrhage risk; Natural history; Surgical outcomes.