• Marco M Fontanella, Luca Zanin, PierPaolo Panciani, Francesco Belotti, Francesco Doglietto, Alice Cremonesi, Karol Migliorati, Elena Roca, Lucio De Maria, Alberto Franzin, Oscar Vivaldi, Federico Griva, Alessandro Narducci, Riccardo Draghi, Fabio Calbucci, Ignazio Borghesi, Emanuela Crobeddu, Christian Cossandi, Antonio Fioravanti, Jahard Aliaga Arias, Alba Scerrati, Pasquale De Bonis, Davide Locatelli, Edoardo Agosti, Pierlorenzo Veiceschi, Marco Ceraudo, Gianluigi Zona, Roberto Gasparotti, Lodovico Terzi di Bergamo, and Daniele Rigamonti.
• Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
• World Neurosurg. 2022 Jun 1; 162: e597e604e597-e604.

ObjectiveSurgical indications for cerebral cavernous malformations (CCMs) remain significantly center- and surgeon-dependent; available grading systems are potentially limited, as they do not include epileptologic and radiologic data. Several experienced authors proposed a new grading system for CCM and the first group of patients capable of providing its statistical validation was analyzed.MethodsA retrospective series of 289 CCMs diagnosed between 2008 and 2021 was collected in a shared anonymous database among 9 centers. The new grading system ranges from -1 to 10. For each patient with cortical and cerebellar cavernous malformations the grading system was applied, and a retrospective outcome analysis was performed. We proposed a score of 4 as a cutoff for surgical indication.ResultsOperated patients with a score ≥4 were grouped with non-operated patients with a score <4, as they constituted the group that received correct treatment according to the new grading system. Patients with a score ≥4, who underwent surgery and had an improved outcome, were compared to patients with a score ≥4 who were not operated (P = 0.04), and to patients with a score <4 who underwent surgery (P < 0.001).ConclusionsThis preliminary statistical analysis demonstrated that this new grading would be applicable in surgical reality. The cutoff score of 4 correctly separated the patients who could benefit from surgical intervention from those who would not. The outcome analysis showed that the treated patients in whom the grading system has been correctly applied have a better outcome than those in whom the grading system has not been applied.Copyright © 2022 Elsevier Inc. All rights reserved.

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