Comparative outcomes of surgical and conservative management of pediatric intracranial cavernous malformations: a systematic review and meta-analysis.
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OBJECTIVE: Pediatric cavernous malformations (CMs) represent a challenging condition in neurosurgery due to their unpredictable nature and potential for neurological deficits. This study aimed to explore the management strategies for pediatric CM, focusing on identifying the factors that influence the choice between conservative and surgical treatment. METHODS: A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The review included a comparative meta-analysis to summarize patient characteristics and outcomes stratified by treatment modality. RESULTS: Thirteen comparative studies with 775 patients were included, with 56.5% (438 patients) in the surgically managed group and 43.5% (337 patients) conservatively managed. The mean ± SD methodological index for nonrandomized studies (MINORS) was 12.4 ± 3.3. Equal proportions of males were in both groups. The surgical group had higher prevalence rates of seizure (51.3% vs 21.0%), signs of elevated intracranial pressure (6.2% vs 0.7%), and hemorrhage (65.9% vs 28.8%). Seizure (OR 3.8, 95% CI 2.4-5.8, p < 0.001, I2 = 2.0%) and hemorrhage (OR 4.6, 95% CI 1.5-13.7, p < 0.001, I2 = 61.8%) were predictors of surgical management. Lesion characteristics included more isolated lesions (79.4% vs 68.5%) and larger mean lesion size (2.1 cm vs 1.4 cm) in the surgical group. Clinical improvement was reported in 83.8% of surgically treated and 72.6% of conservatively treated patients (p = 0.277), while 77.5% of surgical patients were symptom free compared to 50.5% of conservative patients (p = 0.033) at last follow-up. No deaths were reported in either group. CONCLUSIONS: Conservative management is safe for asymptomatic pediatric CMs. Symptomatic cases, especially with seizures or hemorrhage, often benefit from surgery. Surgical decisions should be individualized, and further research is needed to clarify predictors of surgical benefit.