Santos Alejandro N, Rauschenbach Laurèl, Darkwah Oppong Marvin, Chen Bixia, Herten Annika, Forsting Michael, Sure Ulrich, Dammann Philipp
1Department of Neurosurgery and Spine Surgery, University Hospital Essen; and.
2Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
J Neurosurg. 2020 Oct 16;135(2):410-416. doi: 10.3171/2020.6.JNS201585. Print 2021 Aug 1.
Treatment indications for patients with brainstem cavernous malformations (BSCMs) remain difficult and controversial. Some authors have tried to establish classification tools to identify eligible candidates for surgery. Authors of this study aimed to validate the performance and replicability of two proposed BSCM grading systems, the Lawton-Garcia (LG) and the Dammann-Sure (DS) systems.
For this cross-sectional study, a database was screened for patients with BSCM treated surgically between 2003 and 2019 in the authors' department. Complete clinical records, preoperative contrast-enhanced MRI, and a postoperative follow-up ≥ 6 months were mandatory for study inclusion. The modified Rankin Scale (mRS) score was determined to quantify neurological function and outcome. Three observers independently determined the LG and the DS score for each patient.
A total of 67 patients met selection criteria. Univariate and multivariate analyses identified multiple bleedings (p = 0.02, OR 5.59), lesion diameter (> 20 mm, p = 0.007, OR 5.43), and patient age (> 50 years, p = 0.019, OR 4.26) as predictors of an unfavorable postoperative functional outcome. Both the LG (AUC = 0.72, p = 0.01) and the DS (AUC = 0.78, p < 0.01) scores were robust tools to estimate patient outcome. Subgroup analyses confirmed this observation for both grading systems (LG: p = 0.005, OR 6; DS: p = 0.026, OR 4.5), but the combined use of the two scales enhanced the test performance significantly (p = 0.001, OR 22.5).
Currently available classification systems are appropriate tools to estimate the neurological outcome after BSCM surgery. Future studies are needed to design an advanced scoring system, incorporating items from the LG and the DS score systems.
脑干海绵状血管畸形（BSCM）患者的治疗指征仍然难以确定且存在争议。一些作者试图建立分类工具来确定适合手术的患者。本研究的作者旨在验证两种提议的BSCM分级系统，即劳顿 - 加西亚（LG）系统和达曼 - 苏尔（DS）系统的性能和可重复性。
对于这项横断面研究，在作者所在科室的数据库中筛选2003年至2019年期间接受手术治疗的BSCM患者。纳入研究的患者必须有完整的临床记录、术前增强MRI以及术后至少6个月的随访。采用改良Rankin量表（mRS）评分来量化神经功能和预后。三名观察者独立确定每位患者的LG和DS评分。
共有67例患者符合入选标准。单因素和多因素分析确定多次出血（p = 0.02，OR 5.59）、病变直径（> 20 mm，p = 0.007，OR 5.43）和患者年龄（> 50岁，p = 0.019，OR 4.26）是术后功能预后不良的预测因素。LG评分（AUC = 0.72，p = 0.01）和DS评分（AUC = 0.78，p < 0.01）都是评估患者预后的可靠工具。亚组分析证实了两种分级系统的这一观察结果（LG：p = 0.005，OR 6；DS：p = 0.026，OR 4.5），但两种量表联合使用可显著提高测试性能（p = 0.001，OR 22.5）。
目前可用的分类系统是评估BSCM手术后神经预后的合适工具。未来需要开展研究来设计一种先进的评分系统，纳入LG和DS评分系统中的项目。
