Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
World Neurosurg. 2019 Nov;131:e557-e561. doi: 10.1016/j.wneu.2019.07.222. Epub 2019 Aug 7.
Predicting future hemorrhage risk may allow better selection of patients with cerebral cavernous malformations (CCMs) who will likely benefit from treatment. In this study, we sought to identify predictors of CCM hemorrhage, and to compare subsequent symptomatic hemorrhage risks between patients with and without previous hemorrhage.
We performed a retrospective review of consecutive CCM patients at our institution between 1982 and 2017. Patients with diffuse or familial CCM syndromes, and those without follow-up data were excluded. The primary endpoint was acute symptomatic hemorrhage causing transient or permanent neurological symptoms. Primary endpoint incidences were compared between patients with and without previous hemorrhage.
The study cohort comprised 84 patients with 90 CCMs. Previous hemorrhage was the only significant predictor for the primary endpoint (P = 0.003). CCMs with previous hemorrhage had a higher risk of symptomatic hemorrhage in follow-up than those without previous hemorrhage (26.9 vs. 1.5 symptomatic hemorrhages per 1000 CCM-months, P < 0.001). CCMs with and without previous hemorrhage had annual hemorrhage rates of 2.7% and 0.15%, respectively. Symptomatic hemorrhage-free survival rates were significantly lower in CCMs with previous hemorrhage (log-rank test, P < 0.001). Actuarial hemorrhage-free survival rates for CCMs with previous hemorrhage were 75%, 60%, 60%, and 60% at 1, 2, 3, and 4 years, respectively, compared with rates of 95%, 95%, 95%, and 84% for CCMs without previous hemorrhage.
Previous hemorrhage is a predictor of subsequent symptomatic hemorrhage in CCMs. Compared with CCMs without previous hemorrhage, those with prior hemorrhage have a significantly higher risk of future symptomatic hemorrhage.
预测未来出血风险可能有助于更好地选择可能从治疗中获益的脑动静脉畸形（CCM）患者。本研究旨在确定 CCM 出血的预测因素，并比较既往出血患者与无出血患者之间随后出现症状性出血的风险。
我们对 1982 年至 2017 年期间在我院就诊的连续 CCM 患者进行了回顾性研究。排除弥漫性或家族性 CCM 综合征患者以及无随访数据的患者。主要终点为导致短暂或永久性神经症状的急性症状性出血。比较有和无既往出血患者的主要终点发生率。
研究队列包括 84 例患者的 90 个 CCM。既往出血是主要终点的唯一显著预测因素（P=0.003）。与无既往出血的 CCM 相比，有既往出血的 CCM 在随访中出现症状性出血的风险更高（26.9 次 vs. 1000 个 CCM 月中 1.5 次症状性出血，P<0.001）。有和无既往出血的 CCM 的年出血率分别为 2.7%和 0.15%。有既往出血的 CCM 的症状性出血无复发生存率明显较低（对数秩检验，P<0.001）。有既往出血的 CCM 的出血无复发生存率分别为 1、2、3 和 4 年时的 75%、60%、60%和 60%，而无既往出血的 CCM 的相应比率分别为 95%、95%、95%和 84%。
既往出血是 CCM 随后发生症状性出血的预测因素。与无既往出血的 CCM 相比，有既往出血的 CCM 未来发生症状性出血的风险显著更高。
