• Philipp Dammann, Adib A Abla, Rustam Al-Shahi Salman, Hugo Andrade-Barazarte, Vladimir Benes, Marco Cenzato, E Sander Connolly, Jan F Cornelius, William T Couldwell, Rafael G Sola, Santiago Gomez-Paz, Erik Hauck, Juha Hernesniemi, Juri Kivelev, Giuseppe Lanzino, R Loch Macdonald, Jacques J Morcos, Christopher S Ogilvy, Hans-Jakob Steiger, Gary K Steinberg, Alejandro N Santos, Laurèl Rauschenbach, Marvin Darkwah Oppong, Börge Schmidt, Robert F Spetzler, Karl Schaller, Michael T Lawton, and Ulrich Sure.
• 1Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany.
• J. Neurosurg. 2022 May 1; 136 (5): 122012301220-1230.

ObjectiveIndication for surgery in brainstem cavernous malformations (BSCMs) is based on many case series, few comparative studies, and no randomized controlled trials. The objective of this study was to seek consensus about surgical management aspects of BSCM.MethodsA total of 29 experts were invited to participate in a multistep Delphi consensus process on the surgical treatment of BSCM.ResultsTwenty-two (76%) of 29 experts participated in the consensus. Qualitative analysis (content analysis) of an initial open-ended question survey resulted in 99 statements regarding surgical treatment of BSCM. By using a multistep survey with 100% participation in each round, consensus was reached on 52 (53%) of 99 statements. These were grouped into 4 categories: 1) definitions and reporting standards (7/14, 50%); 2) general and patient-related aspects (11/16, 69%); 3) anatomical-, timing of surgery-, and BSCM-related aspects (22/37, 59%); and 4) clinical situation-based decision-making (12/32, 38%). Among other things, a consensus was reached for surgical timing, handling of associated developmental venous anomalies, handling of postoperative BSCM remnants, assessment of specific anatomical BSCM localizations, and treatment decisions in typical clinical BSCM scenarios.ConclusionsA summary of typical clinical scenarios and a catalog of various BSCM- and patient-related aspects that influence the surgical treatment decision have been defined, rated, and interpreted.

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