Of Bubbles and Layers: Which Cerebral Cavernous Malformations are Most Difficult to Dissect From Surrounding Eloquent Brain Tissue?
BACKGROUND
Cerebral cavernous malformations (CCM) may lead to repetitive intracerebral hemorrhage. In selected cases, a surgical resection is indicated.


OBJECTIVE
To identify magnetic resonance imaging (MRI) features of CCM that correlate with the difficulty of dissection and postoperative outcome.


METHODS
This study prospectively analyzed pre- and postoperative MRI features, intraoperative findings (surgical questionnaire), and postoperative outcome of 41 patients with eloquent CCM. Based on the results of the surgeon's questionnaire and postoperative MRI findings, all surgical procedures were dichotomized in a "difficult" (group A) or "not difficult" (group B) lesion dissection. Based on the correlation of preoperative MRI features with groups A and B, a 3-tiered classification was established and tested for sensitivity and specificity.


RESULTS
In 22 patients, dissection of the lesion was rated difficult. This was significantly correlated with amount of postoperative diffusion restriction on MRI ( P = .001) and postoperative outcome ( P = .05). Various preoperative MRI features were tested for correlation and combined in a 3-tiered classification. Receiver operating characteristics revealed excellent and good results for predicting difficulty of dissection for the different classification types.


CONCLUSIONS
We provide a meticulous analysis and new classification of preoperative MRI features that seem to be involved in the microsurgical resection of CCM.
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Philipp
P
Dammann
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Karsten
K
Wrede
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Ramazan
R
Jabbarli
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Oliver
O
Müller
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Christoph
C
Mönninghoff
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Michael
M
Forsting
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Ulrich
U
Sure
D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies
Cavernoma; Cerebral cavernous malformation (CCM); Intracerebral hemorrhage; Microsurgery; Outcome