In people younger than 45, the presence of a cavernous malformation (CM) in the infratentorial region and the existence of a developmental venous anomaly (DVA) are reliable predictors for the risk of haemorrhage, according to retrospective findings of recently published German research.
In this retrospective analysis, investigators at the University Hospital Frankfurt and Institute of Biostatistics and Mathematical Modelling, Goethe University, Frankfurt, obtained medical records of 154 patients with a CM who were admitted to a single centre between 1999 and 2016.
Investigators evaluated patients' baseline characteristics (age, antithrombotic therapy, hypertension, and sex), lesion locations, presence of DVA, and cavernoma volume. For the primary outcome, investigators sought to identify the presence of ≥1 ruptured CM to identify risk factors for haemorrhage.
In the cohort, a total of 89 patients (58%) had ≥1 CM rupture upon hospital admission. Participants with ruptures were significantly more likely to have a DVA compared with patients with ruptures (odds ratio [OR] 4.6, P <.001) in the univariable analysis. In the multivariable analysis, young age (<45) (OR 2.2, P <.05), a rupture in the infratentorial region (OR 2.9, P <.01), and the presence of a DVA (OR 4.7, P <.0001) emerged as significant risk factors for haemorrhage.
In addition, CM volume ≥1 cm3 in the ruptured infratentorial region (OR 3.5; P <.0001) and the presence of a DVA in the ruptured supratentorial location (OR 4.16; P <.01) represented additional predictors of haemorrhage risk in these patients.
The study investigators did not compare pre- or post-haemorrhage data, precluding their ability to determine the applicability of the findings to improving clinical practice. In addition, the study's findings may not generalise to patients with CMs in other locations such as the spine, due to the limited patient sample.
Findings from the study suggest that the presence of DVA and ruptures located in the infratentorial region in patients younger than 45 are key independent haemorrhage risk predictors that may “have a key role in deciding patients' surgical or radio-surgical treatment as well as keeping them under clinical and radiologic observation.”
Abstract
Objective: Despite the low annual risk of hemorrhage associated with a cavernous malformation (CM) (0.6%–1.1% per year), the risk of rehemorrhage rate and severity of neurologic deficits is significantly higher; therefore, we aimed to evaluate the rupture risk of CMs depending on various factors.
Methods: We retrospectively analyzed medical records of all patients with CM admitted to our institution between 1999 and April 2016. Cavernoma volume, location of the lesion, existence of a developmental venous anomaly (DVA), number of cavernomas, and patient characteristics (sex, age, hypertension, and antithrombotic therapy) were assessed.
Results: One hundred fifty-four patients with CM were included; 89 (58%) ruptured CMs were identified. In statistical univariable analysis, the existence of a DVA was significantly higher in the ruptured cavernoma group (p < 0.001; odds ratio [OR] 4.6). A multivariable analysis of all included independent risk factors designated young age (<45 years) (p < 0.05; OR 2.2), infratentorial location (p < 0.01; OR 2.9), and existence of a DVA (p < 0.0001; OR 4.7) with significantly higher risk of rupture in our patient cohort. A separate analysis of these anatomical locations, supratentorial vs infratentorial, indicated that the existence of a DVA (p < 0.01; OR 4.16) in ruptured supratentorial cases and CM volume (≥1 cm3) (p < 0.0001; OR 3.5) in ruptured infratentorial cases were significant independent predictors for hemorrhage.
Conclusions: Young age (<45 years), infratentorial location, and the presence of a DVA are associated with a higher hemorrhage risk. CM volume (≥1 cm3) and the existence of a DVA were independently in accordance with the anatomical location high risk factors for CM rupture.
Authors
Sepide Kashefiolasl, Markus Bruder, Nina Brawanski, Eva Herrmann, Volker Seifert, Stephanie Tritt and Juergen Konczalla
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