The role of radiosurgery in preventing haemorrhage in brainstem cavernous malformations remains a subject of debate. This study aims to evaluate whether radiosurgery provides a protective benefit against haemorrhage in these patients. This multicentre, prospective observational study was conducted in 17 centres and enrolled eligible patients with brainstem cavernous malformations consecutively. Data collected included clinical baseline information, radiosurgery planning details, periodic follow-up evaluations, and any adverse radiation effects. The primary outcome of the study was the incidence of first prospective haemorrhage, while the secondary outcome was the development of new or worsening neurological dysfunctions. The impact of radiosurgery was assessed using multivariate Cox regression analysis. From March 2016 to August 2018, the study enrolled 377 patients: 280 in the observation group receiving standard care alone and 97 in the radiosurgery group receiving both radiosurgery and standard care. The overall cohort consisted of 173 females (45.9%) with a mean age of 40.5 years (range, 18-68 years), and there were no significant differences in baseline characteristics between the two groups. After a median follow-up period of 70 months, haemorrhage occurred in 25.0% (n = 70) of patients in the observation group and 10.3% (n = 10) of patients in the radiosurgery group. Multivariate Cox regression analysis identified radiosurgery as an independent protective factor against haemorrhage (hazard ratio 0.379, 95% confidence interval 0.195-0.738, P = 0.004). Following 1:2 propensity score matching, the incidence of prospective haemorrhage were 24.9% (45/181) in the observation group compared to 10.3% (10/97) in the radiosurgery group (hazard ratio 0.379, 95% confidence interval 0.190-0.755, P = 0.006). Adverse radiation effects were observed in 12 patients (12.4%), with none were permanent. Additionally, new or worsening neurological dysfunctions were significantly more common in the observation group (28.9%) compared to the radiosurgery group (16.5%) (P = 0.016). These results suggest that radiosurgery is associated with a low rate of haemorrhage in patients with brainstem cavernous malformations and could provide a benefit in selected patients. However, further research is required to confirm these findings.

中文翻译：

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放射外科与脑干海绵状血管畸形的观察：一项为期 5 年的多中心队列研究


放射外科治疗在预防脑干海绵状血管畸形出血中的作用仍然是一个争论的话题。本研究旨在评估放射外科是否为这些患者提供防止出血的保护作用。这项多中心、前瞻性观察性研究在 17 个中心进行，并连续招募了符合条件的脑干海绵状血管畸形患者。收集的数据包括临床基线信息、放射外科计划详细信息、定期随访评估和任何不良辐射影响。该研究的主要结局是首次前瞻性出血的发生率，而次要结局是新发或恶化的神经功能障碍的发展。使用多变量 Cox 回归分析评估放射外科的影响。从 2016 年 3 月到 2018 年 8 月，该研究招募了 377 名患者：观察组 280 名患者仅接受标准治疗，放射外科组 97 名同时接受放射外科和标准治疗。整个队列由 173 名女性 （45.9%） 组成，平均年龄为 40.5 岁 （范围，18-68 岁），两组之间的基线特征没有显着差异。中位随访 70 个月后，观察组 25.0% （n = 70） 的患者发生出血，放射外科组 10.3% （n = 10） 的患者发生出血。多因素 Cox 回归分析确定放射外科是预防出血的独立保护因素 （风险比 0.379,95% 置信区间 0.195-0.738，P = 0.004）。在 1：2 倾向评分匹配后，观察组预期出血的发生率为 24.9% （45/181），而放射外科组为 10.3% （10/97） （风险比 0.379,95% 置信区间 0.190-0.755，P = 0.006）。在 12 例患者 （12.4%） 中观察到不良辐射影响，没有一个是永久性的。此外，与放射外科组 （28.9%） 相比，观察组 （16.5%） 新发或恶化的神经功能障碍明显更常见 （P = 0.016）。这些结果表明，放射外科治疗与脑干海绵状血管畸形患者的低出血率相关，并可能为特定患者带来益处。然而，需要进一步的研究来证实这些发现。