Surgical treatment of brainstem cavernous malformations: an international Delphi consensus
: Dammann Philipp, Abla Adib A, Al-Shahi Salman Rustam, Andrade-Barazarte Hugo, Benes Vladimir, Cenzato Marco, Connolly E Sander, Cornelius Jan F, Couldwell William T, Sola Rafael G, Gomez-Paz Santiago, Hauck Erik, Hernesniemi Juha, Kivelev Juri, Lanzino Giuseppe, Macdonald R Loch, Morcos Jaques J, Ogilvy Christopher S, Steiger Hans-Jakob, Steinberg Gary K, Santos Alejandro N, Rauschenbach Laurèl, Darkwah Oppong Marvin, Schmidt Börge, Spetzler Robert F, Schaller Karl, Lawton Michael T, Sure Ulrich
Publisher: American Association of Neurological Surgeons
: 2022
: Journal of Neurosurgery
: Journal of neurosurgery
: J Neurosurg
: 136
: 5
: 1220
: 1230
: 0022-3085
: 1933-0693
DOI: https://doi.org/10.3171/2021.3.JNS2156
OBJECTIVE
Indication for surgery in brainstem cavernous malformations (BSCMs) is based on many case series, few comparative studies, and no randomized controlled trials. The objective of this study was to seek consensus about surgical management aspects of BSCM.
METHODS
A total of 29 experts were invited to participate in a multistep Delphi consensus process on the surgical treatment of BSCM.
RESULTS
Twenty-two (76%) of 29 experts participated in the consensus. Qualitative analysis (content analysis) of an initial open-ended question survey resulted in 99 statements regarding surgical treatment of BSCM. By using a multistep survey with 100% participation in each round, consensus was reached on 52 (53%) of 99 statements. These were grouped into 4 categories: 1) definitions and reporting standards (7/14, 50%); 2) general and patient-related aspects (11/16, 69%); 3) anatomical-, timing of surgery–, and BSCM-related aspects (22/37, 59%); and 4) clinical situation–based decision-making (12/32, 38%). Among other things, a consensus was reached for surgical timing, handling of associated developmental venous anomalies, handling of postoperative BSCM remnants, assessment of specific anatomical BSCM localizations, and treatment decisions in typical clinical BSCM scenarios.
CONCLUSIONS
A summary of typical clinical scenarios and a catalog of various BSCM- and patient-related aspects that influence the surgical treatment decision have been defined, rated, and interpreted.
