gms | German Medical Science

Objective: Primary: To assess clinical and radiological findings and postoperative outcome in patients undergoing surgical treatment for cerebral cavernous malformation (CCM). Secondary: To assess differences in patients presenting with or without associated developmental venous anomaly (DVA).

Method: We retrospectively analyzed clinical and radiological data of 194 patients, undergoing neurosurgical treatment for CCM in our department between 2002 and 2012, according to the reporting standards of CCM research. In subanalysis, patient cohorts were grouped according to the MRI presence/absence of a typical DVA nearby the CCM.

Results: Out of 194 patients (mean age 39.9 years, range 1–72 years, 96 male, 98 female), 53 patients presented with seizures, 70 with FND, 42 with headache and 24 with dizziness. 5 patients were asymptomatic. Localization of CCM was supratentorial cortical/subcortical in 119, posterior fossa in 17, deep brain nuclei in 5, brainstem in 40 and spinal in 13 patients. Overall, at the 6 months follow-up, 138 patients (71%) were classified mRs:0–1, 33 patients (17%) mRs:2, 5 patients (3%) mRs:3 and 15 patients (8%) mRs≥4. Mortality was 0.5%. In patients with seizures, EBOS was class I in 83% and class II in 17%. At the first follow-up, 40% of the patients showed clinical improvement, 19% deterioration and 41% were stable. At the last follow-up, these numbers were 61%, 15% and 24%, respectively. MRI follow-up showed remnant/recurrence in 6%, retreatment was performed in 2%. Significant predictors for postoperative deterioration were localization of CCM and patients initial clinical condition. In the complete cohort CCM max diameter was 17 mm ± 7 mm. In DVA cohort max diameter was 17 mm ± 8 mm, in noDVA cohort 16 mm ± 7 mm. Macro hemorrhage (>5 mm) was found in 55% of patients in DVA, respective 42% in noDVA cohort (Chi-Square p=0.1616). Comparing initial symptoms, DVA cohort showed 56% manifestation with seizures or FND, whereas noDVA cohort showed 70% (Chi-Square p=0.098).

Conclusions: These data, reflecting the clinical course after surgical treatment in a large cohort of patients, help to weight up risks of treatment or non-treatment in patients with (a-)symptomatic CCM. Our analysis revealed no significant differences between CCM associated or not associated with DVA regarding extent of (extra-) lesional (macro-) hemorrhage and occurrence of clinical manifestation.