Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA.
Neurosurgery. 2024 Sep 1;95(3):669-675. doi: 10.1227/neu.0000000000002928. Epub 2024 Mar 29.
Microsurgical resection is the only curative intervention for symptomatic brainstem cavernous malformations (BSCMs), but the management of these lesions in older adults (≥65 years) is not well described. This study sought to address this gap by examining the safety and efficacy of BSCM resection in a cohort of older adults.
Records of patients who underwent BSCM resection over a 30-year period were reviewed retrospectively. Baseline characteristics and outcomes were compared between older (≥65 years) and younger (<65 years) patients.
Of 550 patients with BSCM who met inclusion criteria, 41 (7.5%) were older than 65 years. Midbrain (43.9% vs 26.1%) and medullary lesions (19.5% vs 13.6%) were more common in the older cohort than in the younger cohort ( P = .01). Components of the Lawton BSCM grading system (ie, lesion size, crossing axial midpoint, developmental venous anomaly, and timing of hemorrhage) were not significantly different between cohorts ( P ≥ .11). Mean (SD) Elixhauser comorbidity score was significantly higher in older patients (1.86 [1.06]) than in younger patients (0.66 [0.95]; P < .001). Older patients were significantly more likely than younger patients to have poor outcomes at final follow-up (28.9% vs 13.8%, P = .01; mean follow-up duration, 28.7 [39.1] months). However, regarding relative neurological outcome (preoperative modified Rankin Scale to final modified Rankin Scale), rate of worsening was not significantly different between older and younger patients (23.7% vs 14.9%, P = .15).
BSCMs can be safely resected in older patients, and when each patient's unique health status and life expectancy are taken into account, these patients can have outcomes similar to younger patients.
显微外科切除术是治疗有症状脑干海绵状血管畸形（BSCM）的唯一根治性干预手段，但目前对于老年患者（≥65 岁）的此类病变管理尚无明确描述。本研究旨在通过分析一组老年患者的 BSCM 切除术安全性和疗效来填补这一空白。
回顾性分析了 30 年间接受 BSCM 切除术的患者的病历资料。对比了年龄较大（≥65 岁）和年龄较小（<65 岁）患者的基线特征和结局。
在符合纳入标准的 550 例 BSCM 患者中，有 41 例（7.5%）年龄大于 65 岁。与年龄较小的患者相比，老年患者的中脑病变（43.9%比 26.1%）和延髓病变（19.5%比 13.6%）更为常见（P=0.01）。两组患者的 Lawton BSCM 分级系统的组成部分（即病变大小、穿过轴中线、发育性静脉畸形和出血时间）差异无统计学意义（P≥0.11）。老年患者的 Elixhauser 合并症评分平均值（标准差）显著高于年轻患者（1.86[1.06]比 0.66[0.95]；P<0.001）。与年轻患者相比，老年患者在最终随访时的不良结局更为常见（28.9%比 13.8%，P=0.01；平均随访时间为 28.7[39.1]个月）。然而，就相对神经功能结局（术前改良 Rankin 量表评分与最终改良 Rankin 量表评分）而言，老年患者和年轻患者的恶化率差异无统计学意义（23.7%比 14.9%，P=0.15）。
BSCM 可安全地在老年患者中切除，并且当考虑到每位患者独特的健康状况和预期寿命时，这些患者的结局与年轻患者相似。
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