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

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Gustavo da Fontoura Galvão , Gabriel Verly , Pablo Valença , Flávio Sampaio Domingues , Marcello Reis da Silva , Jorge Marcondes
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引用次数: 0

Abstract

Background

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.

Objective

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.

Methods

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.

Results

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).

Conclusion

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.
颅内脑海绵状畸形手术治疗与保守治疗的早期和长期疗效对比:重建时间到事件数据的元分析
背景由于缺乏临床试验的确切证据,脑海绵畸形(CCMs)的临床治疗面临挑战。本荟萃分析评估了不同时间段内手术干预与保守治疗对无症状 CCMs 患者的有效性,以确定最佳治疗策略。方法按照 PRISMA 指南进行了系统综述和重建时间到事件荟萃分析。利用 Kaplan-Meier 曲线汇总的患者数据,分析了比较手术干预与保守治疗 CCMs 的部分研究数据。新的局灶性神经功能缺损(FND)或颅内出血(ICH)是衡量结果的指标。其中,手术干预43例,发生FND/ICH的平均时间为6.372年(95 % CI:3.536-8.005);而观察管理48例,发生FND/ICH的平均时间明显更长,为10.992年(95 % CI:6.070-8.005)。在 2 年时没有发现明显差异(p = 0.910),但在 5 年和 10 年时,手术干预发生的事件更多,平均时间更短(p < 0.0001)。结论这项荟萃分析表明,观察管理可为无症状 CCM 取得良好的长期疗效。尽管目前仍存在争议,但研究结果强调了进一步研究的必要性,尤其是随机对照试验,以完善治疗策略并优化患者护理。
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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