Background

We sought to quantify the risks of neurosurgical excision of cerebral cavernous malformations (CCMs) in a systematic review of cohort studies.

Methods

We updated our previous systematic review by searching OVID Medline, OVID EMBASE, and the Cochrane Library from 1 January 2013 to 30 April 2019. The primary outcome was a composite of death attributed to CCM or surgery, non-fatal symptomatic intracerebral haemorrhage (ICH), or new or worsened persistent non-haemorrhagic focal neurological deficit (FND).

Results

We included 70 cohorts, 67 reporting surgery alone, and three compared surgery to conservative management. A total of 5,089 patients (median age 36 years, 52% female) underwent surgery (total follow-up 19,404 patient-years). The annual rate of the composite outcome was 4.2% (95% CI 2.9 to 5.7; 46 cohorts; I² = 93%), which was higher in cohorts reporting exclusively brainstem CCM (6.0%, 95% CI 4.1–8.3; 25 cohorts, I² = 92%) versus predominantly supratentorial CCM (2.4%, 95% CI 1.3–3.8, 21 cohorts, I² = 86%, p_het = 0.001). The annual rate of the composite outcome was higher in cohorts with > 95% presenting with ICH (6.1%, 95% CI 4.2–8.4; 23 cohorts, I² = 93%) versus others (2.3%, 95% CI 1.2–3.7; 23 cohorts, I² = 83%, p_het = 0.001). The incidence of the composite outcome did not change over time in cohorts of exclusively brainstem CCM (p = 0.7) or predominantly supratentorial CCM (p = 0.5).

Conclusions

The risk of death, ICH, or FND after CCM excision is ~ 4%. This risk is higher for brainstem CCM and CCM that have caused ICH but has not changed over time.

Trial registration

This systematic review was registered (PROSPERO CRD42019131246).

中文翻译：

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脑海绵状血管瘤手术：系统评价和荟萃分析

背景

我们试图在对队列研究的系统评价中量化脑海绵状血管瘤 (CCM) 的神经外科切除术的风险。

方法

我们在 2013 年 1 月 1 日至 2019 年 4 月 30 日期间通过搜索 OVID Medline、OVID EMBASE 和 Cochrane 图书馆更新了我们之前的系统评价。主要结局是由 CCM 或手术导致的死亡、非致命性症状性脑出血 (ICH) 组成的复合结局，或新的或恶化的持续性非出血性局灶性神经功能缺损 (FND)。

结果

我们纳入了 70 个队列，其中 67 个仅报告了手术，3 个将手术与保守治疗进行了比较。共有 5,089 名患者（中位年龄 36 岁，52% 为女性）接受了手术（总随访 19,404 患者年）。复合结局的年率为 4.2%（95% CI 2.9 至 5.7；46 个队列；I ²  = 93%），在仅报告脑干 CCM 的队列中更高（6.0%，95% CI 4.1-8.3；25 个队列, I ²  = 92%) 与主要是幕上 CCM (2.4%, 95% CI 1.3–3.8, 21 个队列, I ²  = 86%, p _het  = 0.001)。在 > 95% 出现 ICH 的队列中，复合结局的年发生率较高（6.1%，95% CI 4.2-8.4；23 个队列，I ² = 93%）与其他人（2.3%，95% CI 1.2-3.7；23 个队列，I ²  = 83%，p _het  = 0.001）。在仅脑干 CCM (p = 0.7) 或主要是幕上 CCM (p = 0.5) 的队列中，复合结果的发生率没有随时间变化。

结论

CCM 切除后死亡、ICH 或 FND 的风险约为 4%。对于脑干 CCM 和引起 ICH 但未随时间变化的 CCM，这种风险更高。

试用注册

该系统评价已注册 (PROSPERO CRD42019131246)。