Dammann Philipp, Herten Annika, Santos Alejandro N, Rauschenbach Laurèl, Chen Bixia, Darkwah Oppong Marvin, Schmidt Börge, Forsting Michael, Kleinschnitz Christoph, Sure Ulrich
1Department of Neurosurgery, University Hospital Essen.
2Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen.
J Neurosurg. 2020 Oct 16;135(2):401-409. doi: 10.3171/2020.6.JNS201823. Print 2021 Aug 1.
The object of this study was to assess outcome after surgery for brainstem cavernous malformations (BSCMs) using functional, health-related quality of life (HRQOL), and psychological surveys to analyze the interrelation of these measurements, and to compare HRQOL and anxiety and depression scores with those in a healthy population.
The authors performed a cross-sectional outcome study of all patients surgically treated for BSCM in their department between January 1, 2003, and December 31, 2019. They assessed functional outcome via the modified Rankin Scale (mRS), health-related quality of life (HRQOL) via the SF-36 and 9-item Life Satisfaction Questionnaire (LISAT-9), cranial nerve and brainstem function using a questionnaire, symptom-based psychological outcome via the Hospital Anxiety and Depression Scale (HADS), and timepoint of a return to previous employment. They analyzed the correlation between absolute (mRS score ≤ 2) and relative (postoperative deterioration in initial mRS score) outcome endpoints and the interrelation of the outcome measures and performed a comparison of HRQOL and HADS scores with findings in a healthy population.
Seventy-four patients were eligible for inclusion in the study. HRQOL was impaired after surgery for BSCM compared to that in a healthy population. This impairment was substantial in patients with an unfavorable functional outcome (mRS > 2) but was also present in those with a favorable outcome (mRS ≤ 2) in selected domains. Psychological impairment was negligible in patients with a favorable outcome and grave in those with an unfavorable outcome. LISAT-9 results revealed that brainstem and cranial nerve symptoms reduce satisfaction mainly in self-care abilities for both unfavorable and favorable outcome patients. Among the brainstem and cranial nerve symptoms, balance impairment showed the most significant impact on HRQOL. Absolute outcome endpoints were superior to relative outcome endpoints in reflecting impairment in HRQOL after surgery.
The study data can improve patient counseling and decision-making in BSCM treatment and may function as a benchmark. The authors report outcomes after BSCM surgery in high detail, emphasizing the specific impact of cranial nerve and brainstem symptoms on HRQOL. When reporting BSCM surgery outcome, absolute outcome endpoints should be applied.
本研究旨在通过功能、健康相关生活质量（HRQOL）和心理调查来评估脑干海绵状畸形（BSCMs）手术后的结果，分析这些测量指标之间的相互关系，并将HRQOL、焦虑和抑郁评分与健康人群进行比较。
作者对2003年1月1日至2019年12月31日期间在其科室接受手术治疗的所有BSCM患者进行了横断面结果研究。他们通过改良Rankin量表（mRS）评估功能结果，通过SF-36和9项生活满意度问卷（LISAT-9）评估健康相关生活质量（HRQOL），使用问卷评估颅神经和脑干功能，通过医院焦虑和抑郁量表（HADS）评估基于症状的心理结果，以及恢复以前工作的时间点。他们分析了绝对（mRS评分≤2）和相对（初始mRS评分术后恶化）结果终点之间的相关性以及结果测量指标之间的相互关系，并将HRQOL和HADS评分与健康人群的结果进行了比较。
74例患者符合纳入研究的条件。与健康人群相比，BSCM手术后HRQOL受损。这种损害在功能结果不佳（mRS>2）的患者中很明显，但在某些领域功能结果良好（mRS≤2）的患者中也存在。心理损害在结果良好的患者中可以忽略不计，而在结果不佳的患者中则很严重。LISAT-9结果显示，脑干和颅神经症状主要降低了结果不佳和良好患者在自我护理能力方面的满意度。在脑干和颅神经症状中，平衡障碍对HRQOL的影响最为显著。绝对结果终点在反映手术后HRQOL损害方面优于相对结果终点。
研究数据可改善BSCM治疗中的患者咨询和决策，并可作为一个基准。作者详细报告了BSCM手术后的结果，强调了颅神经和脑干症状对HRQOL的具体影响。在报告BSCM手术结果时，应采用绝对结果终点。
