Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: a single-center experience
Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: a single-center experience
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DOI：
10.1007/s10143-019-01210-4
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发表时间：
2020-02-20
影响因子：
2.8
通讯作者：
Zhao, Jizong
中科院分区：
文献类型：
--
作者：
Deng, Zhenghai;Chen, Yu;Zhao, Jizong
比较儿科出血性动静脉畸形（AVMs）的手术干预后的长期神经预后和预后预测因素相对较少，特别是在手术时机的选择上。本研究的目的是阐明这些观点。作者回顾性回顾了2010年3月至2017年6月在其神经外科切除的儿童出血性动静脉畸形。自然历史表现为破裂风险。采用改良Rankin量表（mRS）对儿童进行神经预后评估。采用多因素logistic回归分析评估致残危险因素（mRS bbbb2）。出血早期定义为出血后少于30天。通过倾向-评分匹配（PSM）比较不同手术时机（早期干预或延迟干预）的预后。对111例儿科出血性动静脉畸形患者进行了评估。患者平均年龄11.1 +/- 4.0岁，平均随访4.3 +/- 2.1年。出血性动静脉畸形破裂的年化风险为9.3%，再破裂的年化风险为9.8%。最后一次随访时，7.2%的患者出现神经功能障碍（mRS < 2）， 82.0%的患者无神经功能缺损（mRS < 2）。术前mRS （P = 0.042）和血流相关动脉瘤（P = 0.039）是导致长期残疾的独立因素。在短期结局方面，早期干预优于延迟干预（P = 0.033），但两组长期结局相似（P = 0.367）。儿童出血性动静脉畸形推荐手术治疗，大多数患者能获得良好的神经预后。此外，在初次出血后，首选早期手术干预。
Comparison in pediatric hemorrhagic arteriovenous malformations (AVMs) to clarify the long-term neurological outcomes and prognostic predictors after surgical intervention was relatively rare, especially in the selection of surgical timing. The objective of this study was to elucidate these points. The authors retrospectively reviewed the pediatric hemorrhagic AVMs resected in their neurosurgical department between March 2010 and June 2017. The natural history was represented by rupture risk. Neurological outcome was assessed with the modified Rankin Scale (mRS) for children. Multivariate logistic regression analyses were used to assess the risk factors for disability (mRS > 2). The hemorrhagic early phase was defined as less than 30 days after bleeding. The corresponding prognosis of different surgical timing (early intervention or delayed intervention) was compared after propensity-score matching (PSM). A total of 111 pediatric hemorrhagic AVM patients were evaluated. The average patient age was 11.1 +/- 4.0 years, with a mean follow-up of 4.3 +/- 2.1 years. The annualized rupture risk was 9.3% for the pediatric hemorrhagic AVMs, and the annualized re-rupture risk was 9.8%. 7.2% of the patients had disabilities (mRS > 2) and 82.0% achieved neurological deficit-free (mRS < 2) at the last follow-up. Pre-treatment mRS (P = 0.042) and flow-related aneurysms (P = 0.039) were independent factors for long-term disability. In terms of short-term outcomes, early intervention was better than delayed intervention (P = 0.033), but the long-term outcomes were similar between the two groups (P = 0.367). Surgical intervention for pediatric hemorrhagic AVMs is recommended, most of the patients can achieve good neurological outcomes. Moreover, early surgical intervention is preferred after the initial hemorrhage.