Cerebral cavernous malformation remnants after surgery: a single-center series with long-term bleeding risk analysis
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ORIGINAL ARTICLE
Cerebral cavernous malformation remnants after surgery: a single-center series with long-term bleeding risk analysis Marco M. Fontanella 1 & Edoardo Agosti 1,2
&
Luca Zanin 1 & Lodovico Terzi di Bergamo 3 & Francesco Doglietto 1
Received: 20 June 2020 / Revised: 1 October 2020 / Accepted: 4 November 2020 # The Author(s) 2020
Abstract The aim of this work is to investigate the long-term bleeding risk of cerebral cavernous malformation (CCM) remnants. A review of clinical, radiological, operative, and post-operative data of a cerebral cavernous malformation (CCMs) prospective database was performed. Fisher’s exact test and Mann-Whitney U-test were used to assess differences between non-hemorrhagic and hemorrhagic CCM remnants for 14 variables. Recursive partitioning analysis was performed to assess the order of variables most associated with CCM remnant bleeding. Twenty-four patients out of 126 had a CCM post-surgical remnant. Of these, 7 had at least one post-operative hemorrhagic event. The mean follow-up was 80.7 months (range 12–144). CCM post-surgical remnant bleeding presented mostly with acute headache (50%) and focal neurological deficit (25%); in the remaining cases, the hemorrhage was asymptomatic. Retreatment was performed in two patients, with surgery and radiosurgery, respectively; no treatment was performed in the majority of cases. All patients ranked as non-II, according to Zabramski classification, did not show any post-surgical bleeding. The presence of a pre-operative perilesional hemosiderin ring was highly significant in predicting postsurgical bleeding (sensitivity = 0.94, specificity = 0.88) and incorrectly predicted bleeding in only two of the 24 patients. This study provides an evaluation of clinical and radiological factors influencing the bleeding risk of a CCM post-surgical remnant in a homogeneous population. Perilesional hemosiderin ring and Zabramski Type II appear to strongly condition the bleeding risk of a CCM post-surgical remnant. Keywords Cerebral cavernous malformation . Bleeding risk analysis . Post-surgical bleeding
Introduction Cerebral cavernous malformations (CCMs) are vascular lesions, histopathologically constituted by dilated vascular channels containing blood products at different stages and with a thin wall, formed by a single layer of endothelial cells and a delicate fibrous adventitia [1–3]. The tight junctions between the endothelial cells of these vascular caves are incomplete and dysfunctional, favoring bleeding of the lesion and the deposition of a perilesional hemosiderin ring [4, 5]. * Edoardo Agosti [email protected] 1
2
3
Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy Institute of Oncology Research, Bellinzona, Switzerland
Complete surgical removal of a cerebral cavernous malformation (CCM) is mainly influenced by
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