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Research paper
A risk factor analysis of prospective symptomatic haemorrhage in adult patients with cerebral cavernous malformation
  1. Jin Sue Jeon1,
  2. Jeong Eun Kim1,
  3. Young Seob Chung1,
  4. Sohee Oh2,
  5. Jun Hyong Ahn1,
  6. Won-Sang Cho1,
  7. Young-Je Son1,
  8. Jae Seung Bang1,
  9. Hyun-Seung Kang1,
  10. Chul-Ho Sohn3,
  11. Chang Wan Oh1
  1. 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
  2. 2Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea
  3. 3Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
  1. Correspondence to Dr Jeong Eun Kim, Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; eunkim{at}snu.ac.kr

Abstract

Objective The purpose of this study was to assess the risk factors of prospective symptomatic haemorrhage in a large series of adult patients with cerebral cavernous malformation (CM).

Methods Three hundred twenty-six patients >18 years of age with 410 CMs were evaluated retrospectively. Symptomatic haemorrhage was defined as new clinical symptoms with radiographic features of haemorrhage. Clinical data and the characteristics of CM were analysed. MR appearance was divided into three groups according to Zabramski's classification.

Results The overall haemorrhage rate of CM was 4.46% per lesion-year. The overall annual haemorrhage rate according to MR appearance was as follows: type I, 9.47%; type II, 4.74%; and type III, 1.43%. A multivariate analysis revealed that prior symptomatic haemorrhage (p<0.001) and MR appearance (p<0.001) were statistically significant. After multiple comparisons, type I (p<0.001) and type II (p=0.016) showed higher haemorrhage risk than type III. However, no significant difference in haemorrhage rate was observed between type I and type II (p=0.105). Other variables including female gender, age, location, multiplicity, hypertension, size and associated venous angioma were not significant. The haemorrhage rates based on risk factors were estimated at 3 years as follows: 33.77% in patients with prior haemorrhage versus 7.54% in patients without prior haemorrhage (p<0.001); type I, 27.62% vs type II, 15.44% vs type III, 5.38% (p<0.001).

Conclusions Prior symptomatic haemorrhage and MR appearance could be related to prospective symptomatic CM haemorrhage in adults. A prospective multicentre observational study is necessary to confirm our results.

  • Neurosurgery

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