■症状性脑干海绵状畸形(BSCMs)由于复发性出血而具有很高的发病和死亡风险,保证积极的管理。然而,很少有研究比较不同治疗方式对BSCM的有效性,我们旨在评估BSCM患者治疗方式与复发性出血和神经系统预后的关系。
■我们使用覆盖中国西南和东南人群的观察登记数据库进行了一项回顾性队列研究。纳入BSCM成年患者,并在2011年3月1日至2023年3月31日期间进行随访。我们比较了倾向评分匹配病例对的显微外科和立体定向放射外科(SRS)结果,纳入人口统计,病史,和病变特征。研究结果包括复发性出血和不良预后(定义为格拉斯哥预后量表评分,<4).使用Cox模型计算95%CI的绝对比率差异和风险比(HR)。
■在736例确诊的BSCM患者中,排除和倾向评分匹配后纳入96对(48对匹配)(平均年龄,43.1[SD,12.1]岁;50%为女性)。在中位5年随访期间,复发性出血无显著差异(4.2%[显微手术]与14.6%[SRS],HR,3.90[95%CI,0.46-32.65];P=0.21)和不良预后(12.5%[显微手术]对8.3%[SRS],HR,0.29[95%CI,0.08-1.08];P=0.07)在显微外科手术和SRS接受者之间观察到。此外,显微手术或SRS与更少的复发性出血相关(HR,0.09[95%CI,0.02-0.39];P=0.001;HR,与保守治疗相比,0.21[95%CI,0.07-0.69];P=0.01)。
■在这项研究中,显微手术和SRS对BSCM都是安全有效的,在复发性出血和不良预后方面具有可比性。然而,由于存在残留混杂因素的可能性,解释应谨慎。
■URL:https://www。chictr.org.cn/;唯一标识符:ChiCTR2300070907。
UNASSIGNED: Symptomatic brainstem cavernous malformations (BSCMs) pose a high risk of morbidity and mortality due to recurrent hemorrhage, warranting aggressive management. However, few studies have compared the effectiveness of different treatment modalities for BSCMs. We aimed to assess the association of treatment modalities with recurrent hemorrhage and neurological outcomes in patients with BSCM.
UNASSIGNED: We conducted a retrospective cohort
study using an observational registry database covering population of southwest and southeast China. Adult patients with BSCM were included and followed up between March 1, 2011, to March 31, 2023. We compared outcomes between microsurgery and stereotactic radiosurgery (SRS) in propensity score-matched case pairs, incorporating demographic, medical history, and lesion characteristics. The outcomes studied included recurrent hemorrhage and poor prognosis (defined as a Glasgow Outcome Scale score, <4). Absolute rate differences and hazard ratios (HRs) with 95% CIs were calculated using Cox models.
UNASSIGNED: Among 736 diagnosed patients with BSCM, 96 (48 matched pairs) were included after exclusions and propensity score matching (mean age, 43.1 [SD, 12.1] years; 50% women). During the median 5-year follow-up, no significant differences in recurrent hemorrhage (4.2% [microsurgery] versus 14.6% [SRS], HR, 3.90 [95% CI, 0.46-32.65]; P=0.21) and poor prognosis (12.5% [microsurgery] versus 8.3% [SRS], HR, 0.29 [95% CI, 0.08-1.08]; P=0.07) were observed between microsurgery and SRS recipients. Furthermore, either microsurgery or SRS correlated with fewer recurrent hemorrhage (HR, 0.09 [95% CI, 0.02-0.39]; P=0.001; HR, 0.21 [95% CI, 0.07-0.69]; P=0.01) compared with conservative treatment.
UNASSIGNED: In this
study, both microsurgery and SRS were safe and effective for BSCM, demonstrated comparable outcomes in recurrent hemorrhage and poor prognosis. However, interpretation should be cautious due to the potential for residual confounding.
UNASSIGNED: URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2300070907.