Title:Infratentorial Cerebral Cavernous Malformation May be a Risk Factor
for Symptomatic Bleeding and Precocity of Symptoms: A Multicenter,
Propensity Score Matched, Case-Control Study
Volume: 21
Issue: 2
Author(s): Gustavo da Fontoura Galvão*, Ricardo Castro Filho, Alexandre Alexandre Martins Cunha, Andre Guimarães Soares, Marcos Antônio Dellaretti Filho and Jorge Marcondes de Souza
Affiliation:
- Department of de Neurosurgery, Federal University of Rio de Janeiro, University Hospital Clementino Fraga Filho,
Rio de Janeiro RJ, Brazil
Keywords:
CCM, Cerebral cavernous malformation, infratentorial, intracranial hemorrhage, symptomatic bleeding, vascular malformation.
Abstract:
Background: Cerebral Cavernous Malformation (CCM) is one of the most common
types of vascular malformation of the central nervous system. Intracerebral hemorrhage, seizures,
and lesional growth are the main clinical manifestations. Natural history studies have tried
to identify many risk factors; however, the clinical course remains highly unpredictable.
Objective: Here, we have analyzed a multicenter CCM cohort looking for the differential clinical data
regarding the patients harboring supra and/or infratentorial cavernous malformations in order to better
understand risk factors involved in the anatomical location of the unique neurosurgical disease.
Methods: We have presented a multicenter, Propensity Score Matched (PSM), case-control
study including 149 consecutive CCM cases clinically evaluated from May 2017 to December
2022 from three different neurosurgical centers. Epidemiological data were defined at each clinical
assessment. Logistic regression was used to identify the independent contribution of each
possible risk factor to the bleeding risk. To balance baseline covariates between patients with
and without symptoms, and specifically between those with and without symptomatic bleeding,
we used a PSM strategy. The Kaplan-Meier curve was drawn to evaluate if patients with infratentorial
lesions had a greater chance of bleeding earlier in their life.
Results: The presence of infratentorial lesions was a risk factor in the multivariate analysis comparing
the bleeding risk with pure asymptomatic individuals (OR: 3.23, 95% CI 1.43 – 7.26,
P = 0.005). Also, having an infratentorial CCM was a risk factor after PSM (OR: 4.56, 95% CI
1.47 - 14.10, P = 0.008). The presence of an infratentorial lesion was related to precocity of
symptoms when the time to first bleed was compared to all other clinical presentations in the
overall cohort (P = 0.0328) and in the PSM group (P = 0.03).
Conclusion: Here, we have provided some evidence that infratentorial cerebral cavernous malformation
may have a more aggressive clinical course, being a risk factor for symptomatic
haemorrhage and precocity of bleeding.
