INTRODUCTION We aimed to evaluate the preferred treatment strategy for patients with symptomatic cerebral cavernous malformations (CCM). METHODS In a decision model, we compared neurosurgical, radiosurgical, and conservative management. A literature review yielded the risks and outcomes of interventions, intracerebral hemorrhage (ICH), and seizures. Patients with CCM rated their quality of life to determine utilities. We estimated the expected number of quality-adjusted life years (QALYs) and the ICH recurrence risk over five years, according to mode of presentation and CCM location (brainstem vs. other). We performed analyses with a time horizon of five years. RESULTS Using the best available data, the expected number of QALYs for brainstem CCM presenting with ICH or focal neurological deficit was 2.84 (95% confidence interval [CI]: 2.54-3.08) for conservative, 3.01 (95% CI: 2.86-3.16) for neurosurgical, and 3.03 (95% CI: 2.88-3.18) for radiosurgical intervention; those for non-brainstem CCM presenting with ICH or focal neurological deficit were 3.08 (95% CI: 2.85-3.31) for conservative, 3.21 (95% CI: 3.01-3.36) for neurosurgical, and 3.19 (95% CI: 2.98-3.37) for radiosurgical intervention. For CCM presenting with epilepsy, QALYs were 3.09 (95% CI: 3.03-3.16) for conservative, 3.33 (95% CI: 3.31-3.34) for neurosurgical, and 3.27 (95% CI: 3.24-3.30) for radiosurgical intervention. DISCUSSION AND CONCLUSION For the initial five years after presentation, our study provides Class III evidence that for CCM presenting with ICH or focal neurological deficit conservative management is the first option, and for CCM presenting with epilepsy CCM intervention should be considered. More comparative studies with long-term follow-up are needed.

中文翻译：

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脑海绵状血管瘤的放射外科、神经外科或不干预：决策分析。

引言 我们旨在评估症状性脑海绵状血管瘤 (CCM) 患者的首选治疗策略。方法 在决策模型中，我们比较了神经外科、放射外科和保守治疗。文献回顾得出了干预、脑出血 (ICH) 和癫痫发作的风险和结果。CCM 患者评估他们的生活质量以确定效用。我们根据表现模式和 CCM 位置（脑干与其他）估计了五年内的预期质量调整生命年 (QALY) 和 ICH 复发风险。我们进行了五年时间范围的分析。结果 使用现有最佳数据，脑干 CCM 出现 ICH 或局灶性神经功能缺损的预期 QALY 数为 2.84（95% 置信区间 [CI]：2.54-3。08) 保守，3.01 (95% CI: 2.86-3.16) 用于神经外科，3.03 (95% CI: 2.88-3.18) 用于放射外科干预；非脑干 CCM 表现为 ICH 或局灶性神经功能缺损，保守治疗为 3.08 (95% CI: 2.85-3.31)，神经外科治疗为 3.21 (95% CI: 3.01-3.36)，神经外科治疗为 3.19 (95% CI: 2.98-3.37) ) 用于放射外科干预。对于伴有癫痫的 CCM，保守治疗的 QALY 为 3.09（95% CI：3.03-3.16），神经外科治疗为 3.33（95% CI：3.31-3.34），放射外科干预为 3.27（95% CI：3.24-3.30）。讨论和结论 对于就诊后的最初五年，我们的研究提供了 III 级证据，表明对于伴有 ICH 或局灶性神经功能缺损的 CCM，保守治疗是首选，对于伴有癫痫的 CCM，应考虑 CCM 干预。