1100 Comparative Evaluations of Postoperative Management for Brainstem Cavernous Malformations in Pediatric and Adult Patients

INTRODUCTION: Pediatric brainstem cavernous malformations (BSCMs) pose challenges due to the lack of standardized management guidelines. Microsurgical resection has shown increasing promise; however, the postoperative course of pediatric BSCMs has not been extensively documented because of the rarity of these lesions and the difficulty of microsurgical resection. METHODS: We retrospectively studied 693 patients who underwent surgery for a BSCM between 1984 and 2023 at three institutions (620 adult, 73 pediatric). Data concerning demographics, presentation, operative approach, outcomes (mRS Scores), postoperative course, and follow-up were compared between the two cohorts. Binary logistic regression determined the effect of preoperative/lesion characteristics on the likelihood of recurrence and cumulative recurrence rate was calculated using the Kaplan-Meier estimator, with initial surgery date set as the starting point and observations censored at the date of last follow-up. For all analyses, significance was set at p<0.05. RESULTS: Pediatric patients were less likely to present with hemorrhage (p=0.0016) and had less total preoperative hemorrhages than adults (p=0.0004); however, they presented with more neurological morbidity (p=0.018). Concerning the lesion, there was no difference in location between the midbrain, pons and medulla (p=0.3978) or in the presence of a DVA (p=0.5361), but pediatric BSCMs were larger (p=0.0108). Standard cranial approaches were used, with no observable differences between the two cohorts (p=0.59). Postoperatively, outcomes were similar; however, pediatric patients had a longer LOS (p=0.0017) and experienced greater recurrence rates (p<0.00001). Binary logistic regression showed association with the pediatric group increases likelihood of recurrence and Kaplan-Meier analysis reveals a greater pediatric cumulative recurrence rate compared to adults, specifically at 2.5 years post-resection. CONCLUSIONS: Pediatric BSCM patients have distinct postoperative trajectories and higher recurrence rates. This study provides new insights to guide neurosurgeons in surveillance and postoperative care.