Recurrence of cavernous malformations after surgery in childhood
Gary Steinberg, Michael Jin, Michael Edwards, Gerald Grant, Laura Prolo
Introduction: Cavernous malformations (CMs) are a commonly treated cerebrovascular anomaly in the pediatric population. However, the data on radiographic recurrence of pediatric CMs after surgery are limited.
Objective: To study the clinical presentation, outcomes, and recurrence rate following surgery for cavernous malformations in children.
Methods: Pediatric patients (≤18yo) with a CM resected at a single institution were retrospectively reviewed. Fisher’s exact test of independence was used to assess differences in categorical variables. Survival was evaluated using the Mantel-Cox method and Cox proportional hazards regression.
Results: Fifty-three patients age 3 months to 18 years old underwent resection for 74 symptomatic CMs between 1996 and 2018. Median length of follow-up was 5.65 years. Patients most commonly presented with seizures (45.3%, n = 24) and the majority of CMs were cortical (56.8%, n = 42). Acute hemorrhage was common at presentation (66.7%, n = 34). Forty-two percent (n=22) of patients presented with multiple CMs and they were more likely to develop de novolesions compared to patients presenting with a single CM (71% vs 3.4%; HR = 14.88 [1.94-114.1]).
Conclusions: Acute hemorrhage and multiple CMs were independently prognostic for higher risk of subsequent surgery. Fifty percent (n=6) of patients with both risk factors required additional surgery within 2.5 years of initial surgery compared to no patients with neither risk factor (n=9; p= 0.0186).
Patients with acute hemorrhage and multiple CMs are high-risk for subsequent surgery and require long term MRI surveillance; however, patients with a single CM may require less frequent routine imaging.