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ObjectiveThere have been few comparative studies of microsurgical excision vs conservative management of cerebral cavernous malformations (CCM) and none of them has reliably demonstrated a statistically and clinically significant difference.MethodsWe conducted a prospective, population-based study to identify and independently validate definite CCM diagnoses first made in 1999-2003 in Scottish adult residents. We used multiple sources of prospective follow-up to assess adults' dependence and to identify and independently validate outcome events. We used univariate and multivariable survival analyses to test the influence of CCM excision on outcome, adjusted for prognostic factors and baseline imbalances.ResultsOf 134 adults, 25 underwent CCM excision; these adults were younger (34 vs 43 years at diagnosis, p = 0.004) and more likely to present with symptomatic intracranial hemorrhage or focal neurologic deficit than adults managed conservatively (48% vs 26%; odds ratio 2.7, 95% confidence interval [CI] 1.1-6.5). During 5 years of follow-up, CCM excision was associated with a deterioration to an Oxford Handicap Scale score 2-6 sustained over at least 2 successive years (adjusted hazard ratio [HR] 2.2, 95% CI 1.1-4.3) and the occurrence of symptomatic intracranial hemorrhage or new focal neurologic deficit (adjusted HR 3.6, 95% CI 1.3-10.0).ConclusionsCCM excision was associated with worse outcomes over 5 years compared to conservative management. Long-term follow-up will determine whether this difference is sustained over patients' lifetimes. Meanwhile, a randomized controlled trial appears justified.Classification of evidenceThis study provides Class III evidence that CCM excision worsens short-term disability scores and increases the risk of symptomatic intracranial hemorrhage and new focal neurologic deficits.

Original publication




Journal article



Publication Date





582 - 589


From the Division of Clinical Neurosciences, Centre for Clinical Brain Sciences (F.M., C.B.J., J.M.H., R.J.S., C.P.W., R.A.-S.S.), and Centre for Population Health Sciences (M.A.H., G.D.M.), University of Edinburgh; the Division of Applied Health Sciences (C.E.C.), University of Aberdeen; and the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK.


Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators, Humans, Hemangioma, Cavernous, Central Nervous System, Intracranial Hemorrhages, Disability Evaluation, Treatment Outcome, Microsurgery, Multivariate Analysis, Odds Ratio, Survival Analysis, Follow-Up Studies, Prospective Studies, Age Factors, Time Factors, Adult, Middle Aged, Scotland, Female, Male