{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:13:35Z","timestamp":1790100815819,"version":"4.0.1"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Cerebral cavernous malformations have been studied widely, but the natural history of brainstem cavernous malformations (CMs) is not well defined, and hemorrhages caused by brainstem CMs are devastating. The goal of this study was to quantify the hemorrhage risks and functional outcomes of patients with brainstem CMs.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This prospective, longitudinal, cohort study included patients with brainstem CMs diagnosed between 1985 and 2012. The clinical courses of all patients were recorded. Predictors of hemorrhage and the overall untreated outcomes were evaluated.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 331 patients (46.5% female) were included, with a mean follow-up duration of 6.5 years. The annual hemorrhage rates in patients initially presenting with hemorrhage with (n = 215) or without (n = 34) focal neurological deficits were 15.9% and 12.4%, respectively. However, the annual hemorrhage rate was 8.7% in patients initially presenting without hemorrhage (n = 82). The risk factors for hemorrhage were female sex (hazard ratio [HR] 1.445, p = 0.041), prior hemorrhage (HR 1.277, p = 0.029), and perilesional edema (HR 1.830, p = 0.002). Overall, neurological function at the most recent assessment was improved compared with neurological function at diagnosis. Additionally, 307 patients (92.7%) improved or stabilized, 268 (81.0%) lived independently, and 95 (28.7%) completely recovered. Predictors favoring complete recovery were no prospective hemorrhage (HR 1.958, p = 0.001), younger age (HR 1.268, p = 0.001), and small lesion size (HR 1.578, p = 0.004).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Patients' initial presentation predicts their prospective annual hemorrhage rate. This study suggests that several strong risk factors for hemorrhage and predictors of brainstem CM outcomes may enable clinicians to evaluate the potential hemorrhage risks of their patients and design personalized treatments.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.3.jns132537","type":"journal-article","created":{"date-parts":[[2014,5,2]],"date-time":"2014-05-02T14:02:02Z","timestamp":1399039322000},"page":"32-41","source":"Crossref","is-referenced-by-count":70,"title":["Hemorrhage risks and functional outcomes of untreated brainstem cavernous malformations"],"prefix":"10.3171","volume":"121","author":[{"given":"Da","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Yu","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-Jun","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Ting","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns132537","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3171\/jns.1995.83.1.0056","article-title":"Natural history of intracranial cavernous malformations","volume":"83","author":"Aiba","year":"1995"},{"key":"b2-jns132537","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3222","DOI":"10.1161\/STROKEAHA.108.515544","article-title":"Hemorrhage from cavernous malformations of the brain: definition and reporting standards","volume":"39","author":"Al-Shahi Salman","year":"2008"},{"key":"b3-jns132537","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/S1474-4422(12)70004-2","article-title":"Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study","volume":"11","author":"Al-Shahi Salman","year":"2012"},{"key":"b4-jns132537","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1161\/01.STR.0000258355.23810.c6","article-title":"Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis","volume":"38","author":"Banks","year":"2007"},{"key":"b5-jns132537","series-title":"Neurosurgery","first-page":"15","article-title":"Temporal clustering of hemorrhages from untreated cavernous malformations of the central nervous system","volume":"49","author":"Barker","year":"2001"},{"key":"b6-jns132537","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1179\/016164105X39914","article-title":"Predictive factors for intracerebral hemorrhage in patients with cavernous angiomas","volume":"27","author":"Cantu","year":"2005"},{"key":"b7-jns132537","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1227\/NEU.0b013e3182077531","article-title":"Surgical strategies in treating brainstem cavernous malformations","volume":"68","author":"Chen","year":"2011"},{"key":"b8-jns132537","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"702","DOI":"10.3171\/jns.1991.75.5.0702","article-title":"An analysis of the natural history of cavernous angiomas","volume":"75","author":"Del Curling","year":"1991"},{"key":"b9-jns132537","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1212\/WNL.0b013e318248de9b","article-title":"Prospective hemorrhage risk of intracerebral cavernous malformations","volume":"78","author":"Flemming","year":"2012"},{"key":"b10-jns132537","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/BF01405501","article-title":"Cavernous malformations of the brain stem. 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