Introduction: Cavernous malformations (CV) are benign vascular malformations of low-flow sinusoidal origin. The location of these lesions within the brainstem may lead to devastating neurological complications related to direct compression and hemorrhage.
Methods: A systematic search and meta-analysis for all studies reporting treatment of brainstem CM was conducted using the major scientific databases. All studies published between 2000 and 2015 and including 10 or more cases were included.
Results: A total of 44 studies fulfilled the inclusion criteria; 34 studies reported surgical treatment (1810 patients), 7 studies reported radiosurgery (264 patients), and 3 studies reported conservative treatment (453 patients). There was no significant difference in age, gender, and CM location between different treatment groups. The mean size was 17.3 mm, 12 mm, and 16 mm for surgery, radiosurgery, and conservative group, respectively (p = 0.22). Pretreatment annual bleeding rate (ABR) was 8.1%, 3%, and 3% in the surgery, radiosurgery, and conservative group, respectively (p = 0.735). Pretreatment annual re-bleeding rate was 34.7% and 34.3% in the surgery and radiosurgery group, respectively (p = 0.705) reflecting the activity of the lesions. Complete resection was achieved in 94.6% of surgically treated CM. Within the radiosurgery and conservative group, the CM regressed in size in 39.8% and 18.9% respectively, and grew in size in 0% and 16.2%, respectively. Posttreatment ABR was 1.7% in the surgery group, all related to residuals, compared to 3.9% and 8.7% in the radiosurgery and conservative group, respectively (p = 0.001). Treatment-related mortality rate was 0.2%, 1.1%, and 0.3% in the surgery, radiosurgery, and conservative group, respectively (p = 0.318).
Conclusions: In this meta-analysis, although surgical group had relatively larger CM and higher pretreatment AHR compared to radiosurgery and conservative group, the difference was not statistically significant. Posttreatment, surgery was associated with significantly lower AHR, while conservative treatment had a significantly higher rate.
Patient Care: By comparing the safety and efficacy of different treatment options for brain stem cavernous malformation, and thus identifying the best treatment options for these eloquent lesions.
Learning Objectives: To compare the safety and efficacy of different treatment options for brain stem cavernous malformation.