2025 Proffered Presentations
S202: NATURAL HISTORY OF BRAINSTEM CAVERNOUS MALFORMATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Brandon M Edelbach, BS1; Ahmad K AlMekkawi, MD2; Adnan Shaik, BS3; Rekha P Swamy, BS3; Emily He, BS3; Karl R Abia-ad, MD4; Ryan A Hess, MD5; James P Caruso, MD6; Carlos A Bagley, MD, MBA2; Tarek Y El Ahmadieh, MD1; Yifei Duan, MD2; Jonathan D Breshears, MD2; 1Loma Linda University Department of Neurosurgery; 2Saint Luke's Marion Bloch Neuroscience Institute Department of Neurosurgery; 3Univeristy of Missouri-Kansas City School of Medicine; 4SUNY Upstate Medical Center, Department of General Surgery; 5The University of Texas Southwestern Department of Plastic Surgery; 6The University of Texas Southwestern Department of Neurosurgery
Objective: This systematic review and meta-analysis aims to synthesize the available evidence on the natural history, hemorrhage rates, risk factors, and clinical outcomes of BSCMs to guide clinical decision-making.
Methods: A literature search was performed in PubMed, Scopus, Medline. Studies reporting on the natural history and clinical outcomes of BSCMs were included. Data on patient demographics, hemorrhage rates, risk factors, and outcomes were extracted and analyzed.
Results: A total of 156 studies involving 5,059 patients with BSCMs were included. The annual hemorrhage rate was 4.27% per patient-year, with a rehemorrhage rate of 31.06% per year. Significant risk factors for hemorrhage included larger lesion size (≥ 10 mm), associated developmental venous anomaly, and prior hemorrhage. At diagnosis, 27% of patients presented with motor deficits, 45% with cranial nerve palsies, and 0.017% with respiratory dysfunction. Surgical intervention was performed in 73.04% of cases, with 67.56% of patients achieving a favorable outcome (modified Rankin Scale score ≤ 2). However, early postoperative morbidity and mortality rates remained significant at 27.2%.
Conclusion: BSCMs carry a substantial risk of hemorrhage and neurological morbidity. The natural history and risk factors identified in this meta-analysis can guide clinical decision-making and patient counseling. Further prospective studies are needed to refine risk stratification and management strategies for BSCMs.
| Parameter | Outcome |
| Number of Patients | 5059 |
| Age | 36.6±11.34 |
| Male : Female Ratio | 0.861 |
| Mean Number of Pre-operative Hemorrhages | 1.89 |
| Hemorrhage rate | 4.27% |
| Re-Hemorrhage rate | 31.06% |
| Time from Hemorrhage to Surgery (days) | 134.5 |
| Duration of Symptoms (weeks) | 55.82 |
| Motor Deficits | 1366 (27%) |
| Cranial Nerve Palsy | 2284 (45%) |
| Respiratory Dysfunction | 85 (0.017%) |
| Parameter | Outcome |
| GTR (%) | 73.04 |
| Follow-up (weeks) | 133.81 |
| Average mRS (pre-operative) | 2.44 |
| Average mRS (post-operative) | 2.20 |
| Average mRS (last follow-up) | 1.67 |
| Post-operative Rebleed (%) | 17.12% |
| Percent Improved (mRS < 2) | 67.56% |
| Percent worse (mRS >2) | 10.23% |
| Death (%) | 1.39% |
| Early morbidity and mortality (%) | 27.2% |
| Complication | Frequency [N(%)] |
| CN palsy | 488 (30.14) |
| Infection | 127 (7.84) |
| Tracheostomy | 131 (8.09) |
| Hemiparesis | 103 (6.36) |
| Dysphagia | 121 (7.47) |
| CSF leak | 83 (5.13) |
| PEG | 81 (5.00) |
| Hemihypesthesia | 56 (3.46) |
| Hydrocephalus | 56 (3.46) |
