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Paper title Is active Follow-Up by serial imaging justified in patients with multiple cerebral cavernous malformations?
Paper code P41
  1. Julia Velz Universitätsspital Zürich Speaker
  2. Martin Stienen Kantonsspital St. Gallen Speaker
  3. Marian Neidert Universitätsspital Zürich
  4. Yang Yang Universitätsspital Zürich
  5. Luca Regli University Hospital of Zurich
  6. Oliver Bozinov Kantonsspital St. Gallen
Form of presentation Poster
  • Joint SSNR | SSNS
Abstract text Objective: The best strategy to perform follow-up of patients with multiple cerebral cavernous malformations (mCCM) is unclear due to the mainly unknown and unpredictable clinical course. Still, serial radiological follow-up is often performed. The objective of this work was to critically question whether active follow-up by serial imaging is justified and has an impact on clinical decision making.
Methods: We included all consecutive patients with mCCM treated and followed at our Department between 2006-2016. Patient data were collected and analyzed retrospectively.
Results: From a total consecutive number of 406 patients with CCM, n = 73 (18.0 %; mean age at first diagnosis 45.2 years (± 2.4); n = 42 male (57.5 %)) were found to harbor multiple lesions (≤5 CCM in 58.9 %; 6-25 in 21.9 %; ≥ 25 in 19.2 %). All of them were followed for a mean of 6.8 years (± 0.85). Conservative treatment was suggested in 43 patients over the complete follow-up period. 30 clinically symptomatic patients underwent surgical extirpation of at least one CCM lesion. 43 surgical procedures were performed in total. None of the 4 patients with intractable epilepsy stayed seizure free after surgery. During 500.5 follow-up years in total, routine follow-up MRI in asymptomatic patients lead to an indication for surgery in only 2 occasions and even those 2 were questionable surgical indications.
Conclusion: In patients with mCCM, patient education and imaging studies in the setting of new clinical symptoms may be superior to a rigid imaging follow-up schedule.