Lauren Harris1, Michiel H F Poorthuis2, Patrick Grover3, Neil Kitchen3, Rustam Al-Shahi Salman4. 1. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. lauren.harris7@nhs.net. 2. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands. 3. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. 4. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. Rustam.al-shahi@ed.ac.uk.
Abstract
BACKGROUND: We sought to quantify the risks of neurosurgical excision of cerebral cavernous malformations (CCMs) in a systematic review of cohort studies. METHODS: We updated our previous systematic review by searching OVID Medline, OVID EMBASE, and the Cochrane Library from 1 January 2013 to 30 April 2019. The primary outcome was a composite of death attributed to CCM or surgery, non-fatal symptomatic intracerebral haemorrhage (ICH), or new or worsened persistent non-haemorrhagic focal neurological deficit (FND). RESULTS: We included 70 cohorts, 67 reporting surgery alone, and three compared surgery to conservative management. A total of 5,089 patients (median age 36 years, 52% female) underwent surgery (total follow-up 19,404 patient-years). The annual rate of the composite outcome was 4.2% (95% CI 2.9 to 5.7; 46 cohorts; I2 = 93%), which was higher in cohorts reporting exclusively brainstem CCM (6.0%, 95% CI 4.1-8.3; 25 cohorts, I2 = 92%) versus predominantly supratentorial CCM (2.4%, 95% CI 1.3-3.8, 21 cohorts, I2 = 86%, phet = 0.001). The annual rate of the composite outcome was higher in cohorts with > 95% presenting with ICH (6.1%, 95% CI 4.2-8.4; 23 cohorts, I2 = 93%) versus others (2.3%, 95% CI 1.2-3.7; 23 cohorts, I2 = 83%, phet = 0.001). The incidence of the composite outcome did not change over time in cohorts of exclusively brainstem CCM (p = 0.7) or predominantly supratentorial CCM (p = 0.5). CONCLUSIONS: The risk of death, ICH, or FND after CCM excision is ~ 4%. This risk is higher for brainstem CCM and CCM that have caused ICH but has not changed over time. TRIAL REGISTRATION: This systematic review was registered (PROSPERO CRD42019131246).
BACKGROUND: We sought to quantify the risks of neurosurgical excision of cerebral cavernous malformations (CCMs) in a systematic review of cohort studies. METHODS: We updated our previous systematic review by searching OVID Medline, OVID EMBASE, and the Cochrane Library from 1 January 2013 to 30 April 2019. The primary outcome was a composite of death attributed to CCM or surgery, non-fatal symptomatic intracerebral haemorrhage (ICH), or new or worsened persistent non-haemorrhagic focal neurological deficit (FND). RESULTS: We included 70 cohorts, 67 reporting surgery alone, and three compared surgery to conservative management. A total of 5,089 patients (median age 36 years, 52% female) underwent surgery (total follow-up 19,404 patient-years). The annual rate of the composite outcome was 4.2% (95% CI 2.9 to 5.7; 46 cohorts; I2 = 93%), which was higher in cohorts reporting exclusively brainstem CCM (6.0%, 95% CI 4.1-8.3; 25 cohorts, I2 = 92%) versus predominantly supratentorial CCM (2.4%, 95% CI 1.3-3.8, 21 cohorts, I2 = 86%, phet = 0.001). The annual rate of the composite outcome was higher in cohorts with > 95% presenting with ICH (6.1%, 95% CI 4.2-8.4; 23 cohorts, I2 = 93%) versus others (2.3%, 95% CI 1.2-3.7; 23 cohorts, I2 = 83%, phet = 0.001). The incidence of the composite outcome did not change over time in cohorts of exclusively brainstem CCM (p = 0.7) or predominantly supratentorial CCM (p = 0.5). CONCLUSIONS: The risk of death, ICH, or FND after CCM excision is ~ 4%. This risk is higher for brainstem CCM and CCM that have caused ICH but has not changed over time. TRIAL REGISTRATION: This systematic review was registered (PROSPERO CRD42019131246).
Authors: Elsa Magro; Jean-Christophe Gentric; Tim E Darsaut; Daniela Ziegler; Michel W Bojanowski; Jean Raymond Journal: J Neurosurg Date: 2016-04-29 Impact factor: 5.115
Authors: Kelly D Flemming; Jonathan Graff-Radford; Jeremiah Aakre; Kejal Kantarci; Giuseppe Lanzino; Robert D Brown; Michelle M Mielke; Rosebud O Roberts; Walter Kremers; David S Knopman; Ronald C Petersen; Clifford R Jack Journal: JAMA Neurol Date: 2017-07-01 Impact factor: 18.302
Authors: Rustam Al-Shahi; Jo J Bhattacharya; David G Currie; Vakis Papanastassiou; Vaughn Ritchie; Richard C Roberts; Robin J Sellar; Charles P Warlow Journal: Stroke Date: 2003-04-17 Impact factor: 7.914
Authors: Colin B Josephson; Jo J Bhattacharya; Carl E Counsell; Vakis Papanastassiou; Vaughn Ritchie; Richard Roberts; Robin Sellar; Charles P Warlow; Rustam Al-Shahi Salman Journal: Neurology Date: 2012-07-03 Impact factor: 9.910
Authors: Margaret A Horne; Kelly D Flemming; I-Chang Su; Christian Stapf; Jin Pyeong Jeon; Da Li; Susanne S Maxwell; Philip White; Teresa J Christianson; Ronit Agid; Won-Sang Cho; Chang Wan Oh; Zhen Wu; Jun-Ting Zhang; Jeong Eun Kim; Karel Ter Brugge; Robert Willinsky; Robert D Brown; Gordon D Murray; Rustam Al-Shahi Salman Journal: Lancet Neurol Date: 2015-12-02 Impact factor: 44.182
Authors: J P Mohr; Michael K Parides; Christian Stapf; Ellen Moquete; Claudia S Moy; Jessica R Overbey; Rustam Al-Shahi Salman; Eric Vicaut; William L Young; Emmanuel Houdart; Charlotte Cordonnier; Marco A Stefani; Andreas Hartmann; Rüdiger von Kummer; Alessandra Biondi; Joachim Berkefeld; Catharina J M Klijn; Kirsty Harkness; Richard Libman; Xavier Barreau; Alan J Moskowitz Journal: Lancet Date: 2013-11-20 Impact factor: 79.321
Authors: Jay P Mohr; Jessica R Overbey; Andreas Hartmann; Rüdiger von Kummer; Rustam Al-Shahi Salman; Helen Kim; H Bart van der Worp; Michael K Parides; Marco A Stefani; Emmanuel Houdart; Richard Libman; John Pile-Spellman; Kirsty Harkness; Charlotte Cordonnier; Ellen Moquete; Alessandra Biondi; Catharina J M Klijn; Christian Stapf; Alan J Moskowitz Journal: Lancet Neurol Date: 2020-07 Impact factor: 44.182