Artikel
Long-term outcome and quality of life after resection of cerebral cavernous malformations
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Autoren
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Jan Frederick Cornelius
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
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Katharina Kürten
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
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Nima Etminan
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
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Hans-Jakob Steiger
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
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Daniel Hänggi
- Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine Universität, Düsseldorf, Deutschland
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: To analyze long-term outcome and quality of life after surgical resection of cerebral cavernous malformations (CCM) with special attention to anatomical localization (brainstem vs. non-brainstem).
Method: We retrospectively analyzed clinical data of 60 patients who underwent surgical resection of CCM in our institution between 2000 and 2010. Clinical, imaging and surgical data were evaluated, respectively. Health-related quality of life (QoL) was evaluated with the Short Form 36 quality of life questionnaire (SF-36). The physical (PCS) and mental health component summary scores (MCS) were calculated. These results were compared to a normative healthy population and other surgical series.
Results: The study population included 60 patients (21 males and 39 females) with a mean age of 39.8 years. 67% (n=40) of the CCMs were supratentorial, 7%, (n=4) cerebellar and 26% (n=16) in the brainstem. Preoperatively, 41 patients (68%) presented with hemorrhage, 24 (40%) with seizures and 23 (38%) with headache, respectively. In the brainstem group (BS) 87.5% had a pre-operative deficit vs. 18.2% in the non-brainstem group (NBS). The operative neurological morbidity was 31.3% for BS vs. 11.4% for NBS. Hospital stay for BS was longer, however this was not significant (15.4 to 9.9 days, p=0.06). After a mean follow-up of 43 months, neurological status improved or persisted as compared to the pre-op status in 75% of BS and all (100%) of NBS. None of the patients had epilepsy in the long-term. In the BS group 69.2% were unable to work as compared to 19.2% of the NBS group (p=0.002). In terms of QoL, SF-36 questionnaire showed significant differences between both subgroups in the PCS (p<0.01) but not in the MCS (p=0.93).
Conclusions: Long-term outcome after surgical treatment of CCM differed for NBS as compared to BS. NBS showed lower permanent neurological impairment, better QoL in physical health and a lower working inability rate. Epilepsy was cured in all cases. Surprisingly, in contrast to the frightening diagnosis of a brainstem CCM there was no difference in QoL parameters for mental health. Consequently, surgical resection of CCM at an early stage with state of the art neurosurgical, -anaesthesiological and -ICU standards results in a favorable outcome.
