Early and long-term outcome of surgical versus conservative management for intracranial cerebral cavernous malformation: Meta-analysis of reconstructed time-to-event data

• Published in: Clinical neurology and neurosurgery Vol. 246; p. 108567
• Main Authors: da Fontoura Galvão, Gustavo, Verly, Gabriel, Valença, Pablo, Domingues, Flávio Sampaio, da Silva, Marcello Reis, Marcondes, Jorge
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-11-2024; Elsevier Limited
• Subjects: Bias; Cavernoma; Cerebral cavernous malformations; Clinical trials; Conservative; Datasets; Hemorrhage; Magnetic resonance imaging; Management; Meta-analysis; Patients; Radiosurgery; Sensitivity analysis; Surgery; Systematic review; Vascular; Cerebral cavernous malformations; Vascular; Surgery; Cavernoma; Conservative
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2024.108567

Cerebral cavernous malformations (CCMs) present challenges in clinical management due to a lack of definitive evidence from clinical trials. Surgical intervention and observational management are commonly used, yet their efficacy and long-term outcomes remain controversial.
This meta-analysis evaluates the effectiveness of surgical intervention versus conservative management in patients with symptomatic CCMs over various time frames to determine optimal treatment strategies.
A systematic review and reconstructed time-to-event meta-analysis were conducted, following PRISMA guidelines. Data from selected studies comparing surgical intervention to conservative management for CCMs were analyzed using pooled patient data from Kaplan-Meier curves. New focal neurological deficit (FND) or intracranial hemorrhage (ICH) were the outcome metrics.
Four eligible studies, comprising 290 patients, were included. Surgical intervention showed 43 events over a mean time to FND/ICH of 6.372 years (95 % CI: 3.536–8.005), while observational management had 48 events with a significantly longer mean time of 10.992 years (95 % CI: 6.070–8.005). No significant difference was found at 2 years (p = 0.910), but at 5 and 10 years, surgical intervention had more events and shorter mean times (p < 0.0001). Sensitivity analysis for previously bleeding CCMs showed no significant difference in events (p = 0.131).
This meta-analysis suggests observational management may achieve favorable long-term outcomes for symptomatic CCMs. Despite ongoing controversies, the findings highlight the need for further research, particularly randomized controlled trials, to refine treatment strategies and optimize patient care.
•CCMs pose significant clinical challenges when symptomatic.•Conservative management may offer a longer time to focal neurological deficit compared to surgical intervention.•Ongoing controversies and lack of definitive evidence, highlighted by a meta-analysis of 290 patients revealing notable disparities in long-term outcomes, require further randomized controlled trials.