Recurrence of Pediatric Brainstem Cavernous Malformations After Resection

Sunday, May 5, 2024

3:47 PM – 3:49 PM CT

Location: S405a

Presenting Author(s)

BJ

Brian Ji

Research Intern
Barrow Neurological Institute
Providence, RI, US

Co-Author(s)

AB

Arnau Benet Cabero, MD

Resident
Barrow Neurological Institute
Phoenix, Arizona, United States
Joshua Catapano, MD

Neurosurgeon
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, 85013, Arizona, USA
Phoenix, Arizona, United States
AE

Adam Eberle, BS

Research Intern
Barrow Neurological Institute
SG

Sirin Gandhi, MBBS

Resident
Barrow Neurological Institute, United States
KJ

Kate Jensen, BA

Medical Student
Creighton University School of Medicine
Phoenix, AZ, US
Michael T. Lawton, MD

Professor of Neurosurgery
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, 85013, Arizona, USA
Phoenix, AZ, US
Khashayar Mozaffari, BS

Medical Student
George Washington University School of Medicine
Laguna Niguel, California, United States
Redi Rahmani, MD

Fellow
Barrow Neurological Institue
Penfield, New York, United States
ER

Ethan Register, n/a

Research Intern
Barrow Neurological Institute, United States
SS

Satvir Saggi, BS

Medical Student
University of California, San Francisco School of Medicine, United States
Lea Scherschinski, MD

Postdoctoral Fellow
Barrow Neurological Institue
Phoenix, AZ, US
NW

Nader Wehbi, BS

Medical Student
University of Arizona College of Medicine, United States

Disclosure(s):

Brian Ji: No financial relationships to disclose

Michael T. Lawton, MD: No financial relationships to disclose

Lea Scherschinski, MD: No financial relationships to disclose

Introduction: Brainstem cavernous malformations (BSCMs) in pediatric patients present a unique set of challenges for neurosurgeons in that they tend to be larger and more likely to rebleed after surgery. However, the recurrence rate of pediatric BSCMs has not been well documented because of the rarity of these lesions and the difficulty of resection. In this study, we sought to determine whether children have an increased risk of BSCM recurrence compared to adults and how presentation affects recurrence rates.

Methods: We retrospectively studied 31 pediatric patients who underwent surgery for a brainstem cavernous malformation between 1993 and 2023 at two institutions. Demographics, presenting symptoms, operative approach, procedural information, outcomes, and complications were analyzed. Cumulative recurrence rate was calculated using the Kaplan-Meier estimator, with initial surgery date set as the starting point and observations censored at the date of last follow-up.

Results: Lesions measured in the pons, midbrain, and medulla were analyzed (58.1%, 25.8%, 16.1%). Seven patients (22.6% of the 31 pediatric patient cohort) demonstrated BSCM recurrence on follow-up imaging. The mean age of patients with recurrent BSCM was 9.4 years, and the oldest was 17 years of age at the time of initial BSCM surgery. Of the seven patients, six patients (85.7%) initially presented with intracranial hemorrhage. The 5-year Kaplan-Meier estimate of the recurrence rate among all pediatric patients was 11.3% (95% CI, 1.7% - 31.2%). Among patients with initial hemorrhage, the 5-year recurrence rate was 13.5% (95% CI, 2.0% - 35.9%).

Conclusion : Pediatric patients with brainstem cavernous malformation, particularly those presenting with intracranial hemorrhage, face a high rate of recurrence. This study provides novel information that can help guide clinicians in the surveillance imaging and management of cavernous malformations post-surgery.