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Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study

Cerebral cavernous malformations (CCMs) are commonly diagnosed, with a low reported rate of haemorrhage on long-term follow-up. The identification of factors predictive of future haemorrhage risk would assist in guiding the management of patients with CCM. The aim of this study was to identify varia...

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Autores principales: Gillespie, Conor S., Alnaham, Khalifa E., Richardson, George E., Mustafa, Mohammad A., Taweel, Basel A., Islim, Abdurrahman I., Hannan, Cathal John, Chavredakis, Emmanuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918566/
https://www.ncbi.nlm.nih.gov/pubmed/36763222
http://dx.doi.org/10.1007/s10143-023-01949-x
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author Gillespie, Conor S.
Alnaham, Khalifa E.
Richardson, George E.
Mustafa, Mohammad A.
Taweel, Basel A.
Islim, Abdurrahman I.
Hannan, Cathal John
Chavredakis, Emmanuel
author_facet Gillespie, Conor S.
Alnaham, Khalifa E.
Richardson, George E.
Mustafa, Mohammad A.
Taweel, Basel A.
Islim, Abdurrahman I.
Hannan, Cathal John
Chavredakis, Emmanuel
author_sort Gillespie, Conor S.
collection PubMed
description Cerebral cavernous malformations (CCMs) are commonly diagnosed, with a low reported rate of haemorrhage on long-term follow-up. The identification of factors predictive of future haemorrhage risk would assist in guiding the management of patients with CCM. The aim of this study was to identify variables associated with haemorrhage, and calculate haemorrhage risk in CCM. We conducted a retrospective study of patients diagnosed with a CCM, managed at a specialist tertiary neuroscience centre (2007–2019). The primary outcome was symptomatic haemorrhage, and secondary outcomes were variables associated with increased risk of haemorrhage, using multivariable Cox regression analysis. Included were 545 patients, with 734 confirmed cavernomas. Median age at diagnosis was 47 (interquartile range [IQR] 35–60), with a median follow-up duration after diagnosis of 46 months (IQR 19–85). Of the patients, 15.0% had multiple lesions (N = 82/545). Symptomatic presentation was observed in 52.5% of patients (N = 286/545). The annual haemorrhage rate was 1.00% per lesion-year (25 events in 2512 lesion-years), and higher in those with symptoms at presentation (1.50% per lesion-year, 22 events vs 0.29%, 3 events, P < 0.001). The variables associated with symptomatic haemorrhage were increased size (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01–1.07, P = 0.004), eloquent location (HR 2.63, 95% CI 1.12–6.16, P = 0.026), and symptomatic haemorrhage at presentation (HR 5.37, 95% CI 2.40–11.99, P < 0.001). This study demonstrated that CCMs have a low haemorrhage rate. Increased size, eloquent location, and haemorrhage at presentation appear to be predictive of a higher risk of haemorrhage, and could be used to stratify management protocols. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10143-023-01949-x.
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spelling pubmed-99185662023-02-12 Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study Gillespie, Conor S. Alnaham, Khalifa E. Richardson, George E. Mustafa, Mohammad A. Taweel, Basel A. Islim, Abdurrahman I. Hannan, Cathal John Chavredakis, Emmanuel Neurosurg Rev Research Cerebral cavernous malformations (CCMs) are commonly diagnosed, with a low reported rate of haemorrhage on long-term follow-up. The identification of factors predictive of future haemorrhage risk would assist in guiding the management of patients with CCM. The aim of this study was to identify variables associated with haemorrhage, and calculate haemorrhage risk in CCM. We conducted a retrospective study of patients diagnosed with a CCM, managed at a specialist tertiary neuroscience centre (2007–2019). The primary outcome was symptomatic haemorrhage, and secondary outcomes were variables associated with increased risk of haemorrhage, using multivariable Cox regression analysis. Included were 545 patients, with 734 confirmed cavernomas. Median age at diagnosis was 47 (interquartile range [IQR] 35–60), with a median follow-up duration after diagnosis of 46 months (IQR 19–85). Of the patients, 15.0% had multiple lesions (N = 82/545). Symptomatic presentation was observed in 52.5% of patients (N = 286/545). The annual haemorrhage rate was 1.00% per lesion-year (25 events in 2512 lesion-years), and higher in those with symptoms at presentation (1.50% per lesion-year, 22 events vs 0.29%, 3 events, P < 0.001). The variables associated with symptomatic haemorrhage were increased size (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01–1.07, P = 0.004), eloquent location (HR 2.63, 95% CI 1.12–6.16, P = 0.026), and symptomatic haemorrhage at presentation (HR 5.37, 95% CI 2.40–11.99, P < 0.001). This study demonstrated that CCMs have a low haemorrhage rate. Increased size, eloquent location, and haemorrhage at presentation appear to be predictive of a higher risk of haemorrhage, and could be used to stratify management protocols. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10143-023-01949-x. Springer Berlin Heidelberg 2023-02-10 2023 /pmc/articles/PMC9918566/ /pubmed/36763222 http://dx.doi.org/10.1007/s10143-023-01949-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/ Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Gillespie, Conor S.
Alnaham, Khalifa E.
Richardson, George E.
Mustafa, Mohammad A.
Taweel, Basel A.
Islim, Abdurrahman I.
Hannan, Cathal John
Chavredakis, Emmanuel
Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
title Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
title_full Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
title_fullStr Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
title_full_unstemmed Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
title_short Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
title_sort predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918566/
https://www.ncbi.nlm.nih.gov/pubmed/36763222
http://dx.doi.org/10.1007/s10143-023-01949-x
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