Introduction Cerebral cavernous angiomas (CCAs) are dilated blood vessels in a venous-capillary vascular bed without brain parenchyma. Surgical resection is preferred; in some cases, targeted radiotherapy or chemotherapy can be applied. Our study aims to investigate treatment modalities in patients diagnosed with CCAs and determine the predictors impacting overall long-term survival,30-day readmission, and postoperative length of stay (LOS).

Methods We queried the National Cancer Database between 2004 and 2016 for patients diagnosed with CCAs.Demographic, clinical, and outcomes data were compiled. Five-year survival for each treatment was compared using the Kaplan-Meier (KM) and Nelson-Aalen (NA) curves with statistical comparisons based on the log-rank test. Multivariate analysis was performed to find the drivers of survival, readmission, and LOS. Supervised machine learning (ML) models were trained to predict survival and model performance was evaluated. Shapley additive explanations (SHAP) were calculated using the best-performing model for survival’s feature importance.

Results A total of 4,392 patients diagnosed with brain cavernous angiomas were analyzed. The most common treatment was surgical resection (N=1,504), followed by chemotherapy (N=155), then radiotherapy (N=78). Age, male sex, black race, patients with Medicaid, CDCC 1 or 3, ventricular cavernous lesion, tumor size, and chemotherapy alone are more likely to predict mortality (p<0.05).CDCC of 2, bilaterally located tumors, and surgical resection alone (p<0.05), were more likely to predict 30-day readmission. Brain stem lesions are more likely to affect the LOS following the resection. (p<0.01). The best-performing ML model predicting mortality was Random Forest (97.3%). Increased odds of survival are associated with surgery alone compared to radiotherapy alone or chemotherapy alone (p<0.005).SHAP showed that age, surgery alone, insurance status and laterality mostly impacted our survival model.

Conclusion This study provides the most comprehensive description of the epidemiologic, treatment, and outcomes for CCMs. Our analysis demonstrates that surgical resection alone significantly improves long-term survival.

Disclosures A. Ghaith: None. M. Ghanem: None. A. Bon Nieves: None. M. Bydon: None. B. Bendok: None.