title: A proposed grading system of brain and spinal cavernomas.
abstract: BACKGROUND
  Most cavernomas in the central nervous system are characterized by a benign natural course. Progressive symptoms warrant surgical removal. In the literature, the factors affecting long-term postoperative outcome are not statistically well confirmed.
  
  
  OBJECTIVE
  To perform a multifactorial analysis of risk factors on a large patient series and to use the results to propose a simple grading scale to predict outcome.
  
  
  METHODS
  We studied 303 consecutive patients with cavernomas treated surgically at our department from 1980 to 2009. Follow-up assessment was performed on average 5.7 years postoperatively (range, 0.2-36 years). The main outcome measure was the patients' condition at the last follow-up on Glasgow Outcome Scale. For statistical analysis, the outcome measure was dichotomized to favorable (Glasgow Outcome Scale 5) and unfavorable (Glasgow Outcome Scale 1-4). Binary logistic regression analysis was used to estimate the effect of age, sex, seizures, preexisting neurological deficits, hemorrhage, and size and location of cavernoma on long-term outcome.
  
  
  RESULTS
  Infratentorial, basal ganglia, or spinal location and preexisting neurological deficit were the only independent risk factors for unfavorable outcome, with relative risks of 2.7 (P = .008) and 3.2 (P = .002), respectively. We formulated a grading system based on a score of 1 to 3. When applied to our series, the proposed grading system strongly correlated with outcome (P < .001, Pearson χ test). The risk for long-term unfavorable outcome was 13%, 22%, and 55% for grades 1 through 3, respectively.
  
  
  CONCLUSIONS
  The proposed grading system showed a convincing correlation with postoperative outcome in surgically treated cavernoma patients.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. juri.kivelev@hus.fi
authors.forename: Juri
authors.initials: J
authors.lastname: Kivelev
authors.forename: Aki
authors.initials: A
authors.lastname: Laakso
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D023261:Glasgow Outcome Scale; D020786:Hemangioma, Cavernous, Central Nervous System / Q000145:classification / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult