Santos Alejandro N, Rauschenbach Laurèl, Gull Hanah Hadice, Olbrich Angelina, Lahl Kirstin, Darkwah Oppong Marvin, Dinger Thiemo F, Rieß Christoph, Chen Bixia, Lenkeit Annika, Schmidt Börge, Li Yan, Jabbarli Ramazan, Wrede Karsten H, Sure Ulrich, Dammann Philipp
Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany.
Eur J Neurol. 2023 Jan;30(1):144-149. doi: 10.1111/ene.15574. Epub 2022 Oct 13.
The purpose of this study was to investigate the 5-year risk of a third bleeding event in cavernous malformations (CMs) of the central nervous system.
Patients with cerebral or spinal CMs treated between 2003 and 2021 were screened using our institutional database. Patients with a complete magnetic resonance imaging dataset, clinical baseline characteristics, and history of two bleeding events were included. Patients who underwent surgical CM removal were excluded. Neurological functional status was obtained using the modified Rankin Scale score at the second and third bleeding. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for a third haemorrhage.
Forty-two patients were included. Cox regression analysis adjusted for age and sex did not identify risk factors for a third haemorrhage. 37% of patients experienced neurological deterioration after the third haemorrhage (p = 0.019). The cumulative 5-year risk of a third bleeding was 66.7% (95% confidence interval [CI] 50.4%-80%) for the whole cohort, 65.9% (95% CI 49.3%-79.5%) for patients with bleeding at initial diagnosis, 72.7% (95% CI 39.3%-92.7%) for patients with a developmental venous anomaly, 76.9% (95% CI 55.9%-90.3%) for patients with CM localization to the brainstem and 75% (95% CI 50.6%-90.4%) for patients suffering from familial CM disease.
During an untreated 5-year follow-up after a second haemorrhage, a significantly increased risk of a third haemorrhage compared to the known risk of a first and second bleeding event was identified. The third bleeding was significantly associated with neurological deterioration. These findings may justify a surgical treatment after a second bleeding event.
本研究旨在调查中枢神经系统海绵状血管畸形（CMs）发生第三次出血事件的5年风险。
利用我们机构的数据库筛选2003年至2021年间接受治疗的脑或脊髓CMs患者。纳入具有完整磁共振成像数据集、临床基线特征以及两次出血事件病史的患者。排除接受过CM手术切除的患者。在第二次和第三次出血时使用改良Rankin量表评分来评估神经功能状态。进行Kaplan-Meier和Cox回归分析以确定第三次出血的累积5年风险。
纳入42例患者。经年龄和性别调整的Cox回归分析未发现第三次出血的危险因素。37%的患者在第三次出血后出现神经功能恶化（p = 0.019）。整个队列第三次出血的累积5年风险为66.7%（95%置信区间[CI] 50.4%-80%），初诊时出血的患者为65.9%（95% CI 49.3%-79.5%），伴有发育性静脉异常的患者为72.7%（95% CI 39.3%-92.7%），CM位于脑干的患者为76.9%（95% CI 55.9%-90.3%），患有家族性CM病的患者为75%（95% CI 50.6%-90.4%）。
在第二次出血后未经治疗的5年随访期间，与已知的第一次和第二次出血事件风险相比，第三次出血的风险显著增加。第三次出血与神经功能恶化显著相关。这些发现可能为第二次出血事件后进行手术治疗提供依据。
