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Long-term functional outcomes and complications of microsurgical resection of brainstem cavernous malformations: a systematic review and meta-analysis

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Abstract

Brainstem cavernous malformations (CMs) encompass up to 20% of all intracranial CMs and are considered more aggressive than cerebral CMs because of their high annual bleeding rates. Microsurgical resection remains the primary treatment modality for CMs, but long-term functional outcomes and complications are heterogenous in the literature. The authors performed a systematic review on brainstem CMs in 4 databases: PubMed, EMBASE, Cochrane library, and Google Scholar. We included studies that reported on the long-term functional outcomes and complications of brainstem CMs microsurgical resection. A meta-analysis was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search yielded 4781 results, of which 19 studies met our inclusion criteria. Microsurgery was performed on 940 patients (mean age 35 years, 46.9% females). Most of the brainstem CMs were located in the pons (n = 475). The pooled proportions of improved, stable, and worsened functional outcomes after microsurgical resection of brainstem CMs were 56.7% (95% CI 48.4–64.6), 28.6% (95% CI 22.4–35.7), and 12.6% (95% CI 9.6–16.2), respectively. CMs located in the medulla were significantly (p = 0.003) associated with a higher proportion of improved outcome compared with those in the pons and midbrain. Complete resection was achieved in 93.3% (95% CI 89.8–95.7). The immediate postoperative complication rate was 37.2% (95% CI 29.3–45.9), with new-onset cranial nerve deficit being the most common complication. The permanent morbidity rate was 17.3% (95% CI 10.5–27.1), with a low mortality rate of 1% from the compiled study population during a mean follow-up of 58 months. Our analysis indicates that microsurgical resection of brainstem CMs can result in favorable long-term functional outcomes with transient complications in the majority of patients. Complete microsurgical resection of the CM is associated with a lower incidence of CM hemorrhage and the morbidity related to it.

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Data and materials used in this systematic review are available upon request.

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Acknowledgements

We would like to thank Kristin Kraus, MSc for her editorial assistance.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Ibrahem Albalkhi & Areez Shafqat

  2. Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom

    Ibrahem Albalkhi

  3. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Othman Bin-Alamer, Arka N. Mallela, Chloe Kuminkoski, Michael J. Lang & Hussam Abou-Al-Shaar

  4. Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Mohamed A. Labib

  5. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Michael T. Lawton

  6. Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, USA

    Jacques J. Morcos

  7. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA

    William T. Couldwell

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  1. Ibrahem Albalkhi
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Contributions

HA, WC, JM, MTL, MJL, MAL: conception and design, provision of study patient, data analysis and interpretation, manuscript writing, final approval of the manuscript. CK, OB, IA, AS, and AM: collection and assembly of data, data analysis and interpretation, manuscript writing. All authors: manuscript.

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Correspondence to Hussam Abou-Al-Shaar.

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10143_2023_2152_MOESM1_ESM.png

Supplementary file1 (PNG 36 KB) Supplementary Figure 1: Newcastle-Ottawa scale for non-randomized studies to determine the quality of the studies

Supplementary file2 (PNG 332 KB) Supplementary Figure 2: Funnel plots for determining the risk of publication bias

Supplementary file3 (DOCX 19.8 KB) Supplementary Table 1: Summary of the presentation based on the location of the CM

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Albalkhi, I., Shafqat, A., Bin-Alamer, O. et al. Long-term functional outcomes and complications of microsurgical resection of brainstem cavernous malformations: a systematic review and meta-analysis. Neurosurg Rev 46, 252 (2023). https://doi.org/10.1007/s10143-023-02152-8

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