The Role of Brainstem Cavernous Malformation Radiographic Depth on Presentation and Outcomes

Sunday, May 5, 2024

4:21 PM – 4:23 PM CT

Location: S405a

Presenting Author(s)

Stefan W. Koester, n/a

Medical Student
Vanderbilt University School of Medicine
Nashville, TN, US

Co-Author(s)

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
JH

Joelle N. Hartke, MD

Resident
Barrow Neurological Institue
Phoenix, Arizona, United States
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
AM

Ali Memon, BS

Medical Student
Barrow Neurological Institue, United States
Redi Rahmani, MD

Fellow
Barrow Neurological Institue
Penfield, New York, United States
Lea Scherschinski, MD

Postdoctoral Fellow
Barrow Neurological Institue
Phoenix, AZ, US

Disclosure(s):

Stefan W. Koester, n/a: No financial relationships to disclose

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

Lea Scherschinski, MD: No financial relationships to disclose

Introduction: Prior studies have demonstrated radiographic features such as size as significant predictors of outcomes on brainstem cavernous malformations (BSCMs), the effect of depth remain obscure. Our aim is to assess the effect of BSCM depth on patient symptomatology and post-operative outcomes.

Methods: Patients undergoing resection of their BSCM at a single center from 9/2010 to 8/2022 were assessed. Laterality of approach, lesion depth (defined from the surface of the ependyma to the closest aspect of the BSCM), achievability of gross total resection (GTR), and recurrence status were collected from patient charts as well as pre-operative and post-operative MRI scans.

Results: 167 patients were included with depths ipsilateral to resection corridor ranging from 0–6.95mm. No correlation was observed between depth and size. Patients presenting with cranial nerve deficits demonstrated greater BSCM depth (2.2 sD1.8 vs 1.6 sD1.5, p=0.03) than those without cranial nerve deficits. No significant difference was observed in depth in patients experiencing intra-operative complications (p=0.5), post-operative cranial nerve deficits (p=0.9), GTR (p=0.3), recurrence (p=0.2), or re-operation (p=0.2). In a sub-group analysis of intermediate grade BSCMs, patients experiencing temporary morbidity post-operatively had deeper lesions (2.5 sD2.2 vs 1.5 sD1.3, p=0.05), however this did not result in permanent morbidity (p=0.6). An optimized threshold of depth for adverse outcomes was determined to be 1.7mm. In a multivariate model for intermediate grade BSCMs including both depth and size, BSCM depth greater than 1.7mm was a significant predictor of cranial nerve deficits at presentation (OR=2.84, 95%CI 1.1-7.3, p=0.03) and temporary morbidity (OR=3.4, 95%CI 1.4-9.2, p=0.01), while size was not a significant factor. However, a size greater than 2.0cm was a significant predictor of final modified Rankin Scale>2 in all lesions (OR=3.0, 95%CI 1.2-7.7, p=0.02) as well as intermediate grade lesions (OR=3.0, 95%CI 1.1-9.0, p=0.04), whereas depth was not a predictor on multivariate analysis.

Conclusion : Depth of BSCMs appears to play a significant role in patient presentation as well as post-operative temporary morbidity yet does not predict post-operative functional outcomes.