{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:49Z","timestamp":1787025769486,"version":"build-2736575974"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Brainstem cavernous malformations (BSCMs) represent a unique subgroup of cavernous malformations with more hemorrhagic presentation and technical challenges. This study aimed to provide individualized assessment of the rehemorrhage clustering risk of BSCMs after the first symptomatic hemorrhage and to identify patients at higher risk of neurological deterioration after new hemorrhage, which would help in clinical decision-making.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A total of 123 consecutive BSCM patients with symptomatic hemorrhage were identified between 2015 and 2022, with untreated follow-up > 12 months or subsequent hemorrhage during the untreated follow-up. Nomograms were proposed to individualize the assessment of subsequent hemorrhage risk and neurological status (determined by the modified Rankin Scale [mRS] score) after future hemorrhage. The least absolute shrinkage and selector operation (LASSO) regression was used for feature screening. The calibration curve and concordance index (C-index) were used to assess the internal calibration and discrimination performance of the nomograms. Cross-validation was further performed to validate the accuracy of the nomograms.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Prior hemorrhage times (adjusted OR [aOR] 6.78 per ictus increase) and Zabramski type I or V (OR 11.04) were associated with rehemorrhage within 1 year. A lower mRS score after previous hemorrhage (aOR 0.38 for a shift to a higher mRS score), Zabramski type I or V (OR 3.41), medulla or midbrain location (aOR 2.77), and multiple cerebral cavernous malformations (aOR 11.76) were associated with worsened neurological status at subsequent hemorrhage. The nomograms showed good accuracy and discrimination, with a C-index of 0.80 for predicting subsequent hemorrhage within 1 year and 0.71 for predicting neurological status after subsequent hemorrhage, which were maintained in cross-validation.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n An individualized approach to risk and severity assessment of BSCM rehemorrhage was feasible with clinical and imaging features.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2022.11.jns222277","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T05:37:11Z","timestamp":1672378631000},"page":"94-105","source":"Crossref","is-referenced-by-count":7,"title":["Rehemorrhage of brainstem cavernous malformations: a benchmark approach to individualized risk and severity assessment"],"prefix":"10.3171","volume":"139","author":[{"given":"Zongze","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"National Center for Neurological Disorders, Shanghai;"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;"},{"name":"Neurosurgical Institute of Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"National Center for Neurological Disorders, Shanghai;"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;"},{"name":"Neurosurgical Institute of Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peixi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"National Center for Neurological Disorders, Shanghai;"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;"},{"name":"Neurosurgical Institute of Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"National Center for Neurological Disorders, Shanghai;"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;"},{"name":"Neurosurgical Institute of Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"National Center for Neurological Disorders, Shanghai;"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;"},{"name":"Neurosurgical Institute of Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;"},{"name":"National Center for Neurological Disorders, Shanghai;"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;"},{"name":"Neurosurgical Institute of Fudan University, Shanghai;"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Lancet Neurol","first-page":"217","article-title":"Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study","volume":"11","author":"Al-Shahi Salman R","year":"2012","unstructured":"Al-Shahi Salman R, Hall JM, Horne MA, Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study. 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