A proposed grading system of brain and spinal cavernomas

Neurosurgery. 2011 Oct;69(4):807-13; discussion 813-4. doi: 10.1227/NEU.0b013e31821ffbb5.


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.

Conclusion: The proposed grading system showed a convincing correlation with postoperative outcome in surgically treated cavernoma patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Neoplasms / classification
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / surgery
  • Child
  • Child, Preschool
  • Female
  • Glasgow Outcome Scale
  • Hemangioma, Cavernous, Central Nervous System / classification
  • Hemangioma, Cavernous, Central Nervous System / pathology*
  • Hemangioma, Cavernous, Central Nervous System / surgery
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Neoplasm Grading / methods*
  • Risk Factors
  • Spinal Cord Neoplasms / classification
  • Spinal Cord Neoplasms / pathology*
  • Spinal Cord Neoplasms / surgery
  • Treatment Outcome
  • Young Adult