How can we optimize the long-term outcome in children with intracranial cavernous malformations? A single-center experience of 61 cases.
Neurosurg Rev
; 45(5): 3299-3313, 2022 Oct.
Article
em En
| MEDLINE
| ID: mdl-35678924
ABSTRACT
The objective is to provide a treatment algorithm for pediatric patients with intracranial cavernous malformations (CMs) based on our experience. Patients < 18 years of age who were treated either surgically or conservatively at the authors' institution between 1982 and 2019 were retrospectively evaluated. A total of 61 pediatric patients were treated at the authors' institution 39 with lobar CMs; 18 with deep CMs, including 12 in the brainstem and 6 in the basal ganglia; and 4 with CMs in the cerebellar hemispheres. Forty-two patients underwent surgery, and 19 were treated conservatively. The median follow-up time was 65 months (1-356 months). In surgically treated patients, lesions were larger (2.4 cm vs 0.9 cm, p < 0.001). In patients with lobar CMs, seizures were more common (72% vs 21%, p = 0.003) in the surgery group than in conservatively managed patients. In deep CMs, modified Rankin scale (mRS) was higher (4 vs 1, p = 0.003) in the surgery group than in conservatively treated patients. At the time of last follow-up, no differences in Wieser outcome class I were seen (86% vs 67%) in lobar CMs, and mRS scores had aligned between the treatment groups in deep CMs (1 vs 0). We encountered no new permanent neurological deficit at time of last follow-up. We propose a treatment algorithm according to lesion location and size, burden of symptoms, epilepsy workup, and further clinical course during observation. A conservative management is safe in pediatric patients with asymptomatic CMs. Gross total resection should be the aim in patients with symptomatic lobar CMs. A less aggressive approach with subtotal resection, when required to prevent neurological compromise, sustainably improves neurological outcome in patients with deep CMs.
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Base de dados:
MEDLINE
Assunto principal:
Tronco Encefálico
/
Hemangioma Cavernoso do Sistema Nervoso Central
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Child
/
Humans
Idioma:
En
Revista:
Neurosurg Rev
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Áustria