Hypertrophic Olivary Degeneration in Brainstem Cavernous Malformations: An Analysis of Predictors and Clinical Implications.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-07-17 DOI:10.1227/neu.0000000000003631

Delal Bektas, Giuseppe Lanzino, Stephen Graepel, Kelly D Flemming

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引用次数: 0

Abstract

Background and objectives: This study aimed to evaluate predictors of hypertrophic olivary degeneration (HOD) in patients with brainstem cerebral cavernous malformations (CCMs) and to examine its association with functional outcomes.

Methods: A cohort of 120 patients with brainstem CCM was analyzed using prospectively collected registry data and retrospective chart reviews. Demographic, clinical, radiological, and surgical data were evaluated. Predictors of HOD and poor functional outcomes were identified through univariate and multivariate analyses.

Results: The cohort included 54 females (45.0%), with a mean age at diagnosis of 43.8 years (SD = 16.5). Symptomatic hemorrhage was present in 70.8% of patients at diagnosis, and 28.3% underwent surgical intervention. Radiographic HOD was observed in 20% of patients (n = 24), with 87% of cases involving lesions within the Guillain-Mollaret triangle (GMT). Larger lesion size (odds ratio [OR] = 1.09, 95% CI: 1.01-1.19, P = .027), pontine location (OR = 19.81, P = .006), and GMT involvement (OR = 25.24, P < .001) were significantly associated with HOD. Repeated symptomatic hemorrhage and surgery, including the extent of resection, did not predict the development of HOD. Patients with HOD had worse functional outcomes at last follow-up (P = .012), with GMT involvement remaining the sole independent predictor of mRS ≥3 (OR = 3.44, P = .040).

Conclusion: HOD reflects trans-synaptic degeneration within the GMT and is strongly associated with lesion location and size. It serves as a radiological marker of cumulative damage to the brainstem. Preoperative imaging and risk stratification focusing on GMT involvement are critical for guiding management and counseling patients with brainstem CCM.

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脑干海绵状血管瘤增生性橄榄变性：预测因素分析及临床意义。

背景和目的：本研究旨在评估脑干脑海绵状畸形（CCMs）患者肥厚性橄榄变性（HOD）的预测因素，并研究其与功能预后的关系。方法：对120例脑干CCM患者进行前瞻性登记资料和回顾性图表分析。评估了人口统计学、临床、放射学和外科数据。通过单变量和多变量分析确定了HOD和功能不良预后的预测因子。结果：该队列包括54名女性（45.0%），平均诊断年龄为43.8岁（SD = 16.5）。70.8%的患者在诊断时出现症状性出血，28.3%的患者接受了手术干预。在20%的患者（n = 24）中观察到影像学上的HOD，其中87%的病例涉及格林-莫拉雷三角区（GMT）内的病变。较大的病变面积（比值比[OR] = 1.09, 95% CI: 1.01-1.19, P = 0.027）、脑桥位置（OR = 19.81, P = 0.006）和GMT累及（OR = 25.24, P < 0.001）与HOD显著相关。反复的症状性出血和手术，包括切除的程度，并不能预测HOD的发展。在最后一次随访中，患有HOD的患者的功能预后较差（P = 0.012）， GMT参与仍然是mRS≥3的唯一独立预测因子（OR = 3.44, P = 0.040）。结论：HOD反映了GMT内的突触变性，并且与病变的位置和大小密切相关。它是脑干累积损伤的放射学标志。术前成像和风险分层关注GMT累及是指导管理和咨询脑干CCM患者的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.