Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
World Neurosurg. 2022 Jun;162:e597-e604. doi: 10.1016/j.wneu.2022.03.070. Epub 2022 Mar 18.
Surgical indications for cerebral cavernous malformations (CCMs) remain significantly center- and surgeon-dependent; available grading systems are potentially limited, as they do not include epileptologic and radiologic data. Several experienced authors proposed a new grading system for CCM and the first group of patients capable of providing its statistical validation was analyzed.
A retrospective series of 289 CCMs diagnosed between 2008 and 2021 was collected in a shared anonymous database among 9 centers. The new grading system ranges from -1 to 10. For each patient with cortical and cerebellar cavernous malformations the grading system was applied, and a retrospective outcome analysis was performed. We proposed a score of 4 as a cutoff for surgical indication.
Operated patients with a score ≥4 were grouped with non-operated patients with a score <4, as they constituted the group that received correct treatment according to the new grading system. Patients with a score ≥4, who underwent surgery and had an improved outcome, were compared to patients with a score ≥4 who were not operated (P = 0.04), and to patients with a score <4 who underwent surgery (P < 0.001).
This preliminary statistical analysis demonstrated that this new grading would be applicable in surgical reality. The cutoff score of 4 correctly separated the patients who could benefit from surgical intervention from those who would not. The outcome analysis showed that the treated patients in whom the grading system has been correctly applied have a better outcome than those in whom the grading system has not been applied.
脑动静脉畸形（CAVMs）的手术适应证仍然严重依赖中心和外科医生；现有的分级系统可能存在局限性，因为它们不包括癫痫学和影像学数据。一些经验丰富的作者提出了一种新的 CAVM 分级系统，第一批能够提供其统计验证的患者被分析。
在 9 个中心的共享匿名数据库中收集了 2008 年至 2021 年间诊断的 289 例 CAVM 的回顾性系列。新的分级系统范围从-1 到 10。对皮质和小脑动静脉畸形的每位患者应用分级系统，并进行回顾性结果分析。我们提出 4 分为手术指征的临界值。
评分≥4 的手术患者与评分<4 的未手术患者分为一组，因为他们构成了根据新分级系统接受正确治疗的组。与评分≥4 且手术结果改善的患者（P=0.04）和评分<4 但手术的患者（P<0.001）相比，评分≥4 且接受手术的患者。
这项初步的统计分析表明，这种新的分级系统将适用于手术现实。4 分的临界值正确地区分了可以从手术干预中获益的患者和不能获益的患者。结果分析表明，正确应用分级系统的治疗患者的结果优于未应用分级系统的患者。
