机构：[1]Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China四川大学华西医院[2]Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China[3]National Center for Neurological Disorders, Shanghai, China[4]Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, China[5]Neurosurgical Institute of Fudan University, Shanghai, China[6]Shanghai Clinical Medical Center of Neurosurgery, China[7]Department of Neurosurgery, Peking University International Hospital, Beijing, China
Symptomatic brainstem cavernous malformations (BSCMs) pose a high risk of morbidity and mortality due to recurrent hemorrhage, warranting aggressive management. However, few studies have compared the effectiveness of different treatment modalities for BSCMs. We aimed to assess the association of treatment modalities with recurrent hemorrhage and neurological outcomes in patients with BSCM.We conducted a retrospective cohort study using an observational registry database covering population of southwest and southeast China. Adult patients with BSCM were included and followed up between March 1, 2011, to March 31, 2023. We compared outcomes between microsurgery and stereotactic radiosurgery (SRS) in propensity score-matched case pairs, incorporating demographic, medical history, and lesion characteristics. The outcomes studied included recurrent hemorrhage and poor prognosis (defined as a Glasgow Outcome Scale score, <4). Absolute rate differences and hazard ratios (HRs) with 95% CIs were calculated using Cox models.Among 736 diagnosed patients with BSCM, 96 (48 matched pairs) were included after exclusions and propensity score matching (mean age, 43.1 [SD, 12.1] years; 50% women). During the median 5-year follow-up, no significant differences in recurrent hemorrhage (4.2% [microsurgery] versus 14.6% [SRS], HR, 3.90 [95% CI, 0.46-32.65]; P=0.21) and poor prognosis (12.5% [microsurgery] versus 8.3% [SRS], HR, 0.29 [95% CI, 0.08-1.08]; P=0.07) were observed between microsurgery and SRS recipients. Furthermore, either microsurgery or SRS correlated with fewer recurrent hemorrhage (HR, 0.09 [95% CI, 0.02-0.39]; P=0.001; HR, 0.21 [95% CI, 0.07-0.69]; P=0.01) compared with conservative treatment.In this study, both microsurgery and SRS were safe and effective for BSCM, demonstrated comparable outcomes in recurrent hemorrhage and poor prognosis. However, interpretation should be cautious due to the potential for residual confounding.URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2300070907.
基金：
This study was funded by National Key Research and Development Program ofChina (2018YFA0108603 and 2018YFA0108604), Natural Science Foundation of Sichuan Province (2022NSFSC1477), and 1·3·5 Project for Disciplinesof Excellence, West China Hospital, Sichuan University (2021HXFH014 and2023HXBH116).
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2025]版：
大类|1 区医学
小类|1 区临床神经病学1 区外周血管病
最新[2025]版：
大类|1 区医学
小类|1 区临床神经病学1 区外周血管病
第一作者：
第一作者机构：[1]Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
共同第一作者：
通讯作者：
通讯机构：[2]Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, China[3]National Center for Neurological Disorders, Shanghai, China[4]Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, China[5]Neurosurgical Institute of Fudan University, Shanghai, China[6]Shanghai Clinical Medical Center of Neurosurgery, China
推荐引用方式(GB/T 7714)：
Lu Junlin,Li Zongze,Deng Hao,et al.Treatment Modalities and Outcomes in Brainstem Cavernous Malformations: A Large Multicenter Observational Cohort Study[J].Stroke.2024,doi:10.1161/STROKEAHA.123.046203.
APA：
Lu Junlin,Li Zongze,Deng Hao,Shi Guangchao,Wang Wei...&Tian Rui.(2024).Treatment Modalities and Outcomes in Brainstem Cavernous Malformations: A Large Multicenter Observational Cohort Study.Stroke,,
MLA：
Lu Junlin,et al."Treatment Modalities and Outcomes in Brainstem Cavernous Malformations: A Large Multicenter Observational Cohort Study".Stroke .(2024)
医学