Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher St. Gallen, Switzerland.
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
World Neurosurg. 2022 Jan;157:e342-e350. doi: 10.1016/j.wneu.2021.10.092. Epub 2021 Oct 14.
Hemorrhage rates of conservatively managed brainstem cavernous malformations (BSCMs) vary widely in the literature. We aimed to elucidate the reason for the variation and to add the results of our experience of BSCMs management over the past decade.
We performed a review of consecutive patients with BSCMs referred to our department in the period 2006-2018. A hemorrhagic event was defined as a radiographically verified intralesional and extralesional hemorrhage. Both retrospective and prospective hemorrhage rates were calculated based on the patient age in years, counted either from birth or from the time of initial presentation until the last contact (or until surgical resection). In addition, we retrieved and reviewed publications with a clear definition of hemorrhagic event and a detailed description of BSCM hemorrhage rate.
In total, 118 patients with BSCMs were reviewed, and 78 patients (mean age on admission 45.9 years) were included in the final analysis. The retrospective and prospective hemorrhage rates were 1.9% (95% confidence interval 1.6%-2.3%) per year and 11.9% (95% confidence interval 7.5%-17.8%), respectively. The retrospective hemorrhage rate in the literature review ranged from 1.9% to 6.8% per year with a median value of 3.8%, whereas the prospective hemorrhage rate ranged between 4.1% and 21.5%, with a median value of 10.2%.
The reported hemorrhage rates are calculated in 2 different ways. In our patient cohort, both the retrospective and prospective hemorrhage rates were in accordance with those in the literature. The long-term hemorrhage rate lies between the prospective and retrospective rate.
文献中保守治疗的脑干海绵状畸形（BSCM）的出血率差异很大。我们旨在阐明这种差异的原因，并增加我们过去十年 BSCM 治疗经验的结果。
我们对 2006 年至 2018 年期间我院收治的连续 BSCM 患者进行了回顾性研究。出血事件定义为影像学证实的瘤内和瘤周出血。根据患者年龄（从出生或从首次就诊到最后一次随访（或直到手术切除）的时间），计算回顾性和前瞻性出血率。此外，我们还检索并回顾了有明确出血事件定义和详细 BSCM 出血率描述的文献。
共对 118 例 BSCM 患者进行了回顾性分析，最终纳入 78 例（入院时平均年龄为 45.9 岁）患者进行分析。回顾性和前瞻性出血率分别为每年 1.9%（95%置信区间 1.6%-2.3%）和 11.9%（95%置信区间 7.5%-17.8%）。文献复习中回顾性出血率每年为 1.9%-6.8%，中位数为 3.8%，前瞻性出血率为 4.1%-21.5%，中位数为 10.2%。
报告的出血率以两种不同的方式计算。在我们的患者队列中，回顾性和前瞻性出血率均与文献中的结果一致。长期出血率介于前瞻性和回顾性之间。
