Clinical course and surgical outcomes of cerebral cavernous malformations: Insights from a large single-center experience

Abstract

Introduction Clinical decision-making for cerebral cavernous malformations (CCMs) requires balancing hemorrhage risk against surgery-related morbidity, yet clinically applicable risk stratification remains limited. Research question To examine hemorrhage during recorded follow-up, postoperative complications, and functional outcomes after conservative and surgical management of CCMs. Material and methods We retrospectively analyzed 268 patients treated between 2014 and 2021. Clinical, radiological, and treatment variables were collected. Functional outcome was assessed using the modified Rankin Scale (mRS), analyzed as an ordinal outcome using paired nonparametric tests. Recorded untreated observation was censored at surgery; hemorrhage rates were reported with exact 95% confidence intervals (CIs). Results At baseline, most patients presented with hemorrhage and 25.4% of lesions were infratentorial. Most were managed conservatively (72.8%), whereas 27.2% underwent surgery. Median time from diagnosis to surgery was 48 days. Postoperative neurological complications occurred in 20/73 patients (27.4%), including seizure-related events (11.0%), diplopia in (4.1%), and hemiparesis in (4.1%). Among 68 surgical patients with paired assessments, median mRS was 1 [IQR 1–1] at baseline and 0 [0–1] at last follow-up; residual disability was greater in brainstem lesions. Two new radiographic hemorrhages were documented during 250.3 person-years in 129 patients with untreated observation (0.80/100 person-years; 95% CI 0.10–2.89). Age was not associated with postoperative complications (OR 1.01/year, 95% CI 0.97–1.04). Discussion and conclusion In this tertiary-center cohort, favorable functional recovery was observed in selected surgical patients, but brainstem CCMs remained associated with residual morbidity. Sparse hemorrhage events and confounding by indication precluded treatment comparisons or a validated risk-stratification framework.