Brainstem Cavernomas: Functional Results and Prognosis Long-Term Follow-Up Cohort of Patients Treated Non-Operatively and Operatively
Authors: HAIDARA Ousmane Toumany Cherif , TOKPA Valentin André Jacques Kouamé , Doumbia Zoumana , MAIGA Youssoufa , MEDARD Kakou Konan , Lonjon Michel 
Published: November 2024

Introduction: Cerebral cavernous malformation (CCM) is an abnormally large collection of low flow vascular channels without brain parenchyma intervening between the sinusoid vessels. Brainstem Cavernoma Malformations (BSCMs) account for 0.5 to 0.9 % in the literature. Functional results, bleeding and subsequent bleeding have been reported in several studies in the literature relative to the management both for surgery and non-operative treatment. Our study aimed to evaluate long term functional outcomes of patients treated both operatively and non-operatively. Materials and Methods: A cohort of 44 patients has been followed for 29 years either retrospectively and prospectively. The retrospective period extended from October 1992 to September 2020 while the prospective one was the one year follow-up (FU) till September 2021. Data have been collected from patients’ archived files, schedule visits to the physician and phone calls. Patients in whom the diagnosis of BSCMs have been confirmed clinically and by image findings were included in our study. Functional status were assessed using both modified Rankin Scale (mRs) score over an interval from 0 to 5 and Karnosky Index (KI) from 0 to 100. Muscle strength was assessed by muscular testing over an interval from 0 to 5. Zero meant absence of muscular contraction while 5 was normal muscle motion. Magnetic Resonance Imaging (MRI) was systematically carried out in patients who had not got imaging control for 2 years. During FU period each patient who presented a new and sudden clinical symptom related to the involvement of brainstem was reassessed clinically and image work-up to rule out a rebleeding episode. Univariate analysis was conducted for establishing statistical significance between early haemorrhages, rebleeding, clinical and demographic features. Results: Forty patients presented 57 bleeding episodes. Thirteen patients (29.54 %) underwent surgery. Thirteen ones had eighteen recurrent bleeding episodes, i.e. a rate of 31.69±0.65 SD. Initial average mRs score was 0.67±0.79 SD for the conservative treatment group while the operated on patients had 2.15±1.14 SD. Postoperatively, mRs score was 2.07±1.44 SD. Final FU mRs was 0.93±00 SD and 1.81±00 SD for non-operative and operative treatment respectively. Surgery reduced the rate of rebleeding (p=0.04). The long-term functional outcome improvement was similar between non-operative and operative treatment (p=0.27). The predictive factors of bleeding and rebleeding reported were woman gender (p=0.0074) and pons location (p=0.0001) while age and Zabramski radiologic type were not significant. Conclusion: Our finding sustains similar functional outcomes to both non-operative and operative treatment. Nevertheless, surgery reduced the rate of rebleeding and remains largely related to the precise patient selection regarding clinical, radiologic and microsurgery features.