gms | German Medical Science

Objective: Despite of the low annual risk of hemorrhage associated with a cavernous malformation (CM) (0,6% to 1,1% per year), the risk of rehemorrhage rate and severity of neurological deficits is significantly higher. We aimed to evaluate different hemorrhage risk factors, particularly in dependence on location as main focus, to define new treatment guidelines for patients with initial diagnosis of CM.

Methods: We retrospectively reviewed medical records of all CM patients admitted to our institution between 1999 and April 2016. Cavernoma volume, anatomical location, existence of a developmental venous anomaly (DVA), number of cavernomas and patient characteristics (sex, age, hypertension and antithrombotic therapy) were analyzed.

Results: 154 CM patients (212 CM lesions) were included, and 89 ruptured CMs were identified. Young age (<45 years) (p<0,05; OR 2,2), infratentorial location (p<0,01; OR 2,9) and the existence of DVA (p<0,0001; OR 4,7) were associated with significant higher risk for CM rupture in our patient cohort. Calculations based on every single CM lesion detected CM size ≥ 1 cm3 (p<0,01; OR 9,9) additionally as an important factor for increased rate of rupture. A separate analysis of different anatomical locations, supratentorial versus infratentorial, indicated the existence of DVA (p<0,01; OR 4,16) in supratentorial and CM volume (≥1 cm³) (p<0,0001; OR 35) in infratentorial cases as significant independent predictors for hemorrhage. Analyzing every single CM lesion in dependence on different locations confirmed previous results.

Conclusion: This study proposed the idea to evaluate hemorrhage rates according to radiologic morphology depending on location. However, to analyze propriety and possible application of our results in daily clinical management of patients with CM, further research is needed. Nevertheless, above mentioned independent hemorrhage predictors can play a key role in individually decision-making process according a surgical or radiosurgical treatment as well as keeping under clinical and radiological observation.