Maximum Nidus Depth as a Risk Factor of Surgical Morbidity in Eloquent Brain Arteriovenous Malformations
Maximum Nidus Depth as a Risk Factor of Surgical Morbidity in Eloquent Brain Arteriovenous Malformations
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最大病灶深度是脑动静脉畸形手术发病率的危险因素
DOI：
10.1007/978-3-030-63453-7_14
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Kawamata Takakazu
中科院分区：
文献类型：
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作者：
Ryu Bikei;Yamaguchi Koji;Ishikawa Tatsuya;Fukui Atsushi;Matsuoka Go;Eguchi Seiichiro; Okada Yoshikazu;Kawamata Takakazu
手术治疗脑动静脉畸形（BAVM）是一种根治性治疗方法。安全和彻底的切除有望有助于防止未来的出血和症状恶化。然而，有些BAVM不适合手术干预，并且已知明确定位的BAVM会增加手术风险[1-4]。特别是在Rolandic区，即运动和感觉区，手术发病率与患者的独立性直接相关。因此，手术治疗这些实体仍然具有挑战性。安全切除Rolandic BAVM的指标是必要的，但迄今为止尚未确定。除了Spetzler-Martin（SM）分级量表[1-4]中包含的众所周知的出血性发作、未破裂BAVM、大小和深静脉引流等因素外，近年来还报告了几个功能性BAVM的手术风险因素，例如通过功能性磁共振成像（fMRI）[5]观察到的运动区的皮质重组和可塑性，通过扩散张量成像（DTI）[6，7]评估的BAVM病变-皮质脊髓束（CST）距离，和通过fMRI评估的BAVM病变至激活区距离（LAD）[8]。它们可以帮助预测功能区的术后神经结局，这些因素有助于获得可接受的长期结局[6，9]，沿着短暂但最终可逆的手术发病率。因此，存在皮质区域的可塑性和皮质重组的可能性。在Rolandic区，CST和深白色纤维的损害可能更为严重和不可逆。然而，由于各种方法的限制，使用DTI和fMRI有时很难产生均匀的图像[10]。成像结果可能因机构和类型而异
Surgical treatment of brain arteriovenous malformations (BAVMs) is a radical treatment modality. Safe and radical removal is expected to help prevent future hemorrhage and symptomatic deterioration. However, there are BAVMs that are unsuitable for surgical intervention and an eloquently located BAVM is known to increase the surgical risk [1–4]. In particular, in the Rolandic area, ie, the motor and sensory areas, surgical morbidity is directly linked to the independence of the patient. Hence, it is still challenging to surgically treat these entities. Indicators for safe removal of Rolandic BAVMs are necessary but have not been determined thus far.In addition to factors such as well-known hemorrhagic onset, unruptured BAVM, size, and deep venous drainage that are included in the Spetzler-Martin (SM) grading scale [1–4], several surgical risk factors for eloquent BAVM have been reported in recent years, such as cortical reorganization and plasticity of motor area visualized via functional magnetic resonance imaging (fMRI)[5], BAVM lesion-tocorticospinal tract (CST) distance assessed by diffusion tensor imaging (DTI)[6, 7], and BAVM lesion-to-activation area distance (LAD) assessed by fMRI [8]. They can help predict postoperative neurological outcomes in the eloquent area and these factors contributed to acceptable long-term outcomes [6, 9], along with transient but finally reversible surgical morbidity. Thus, there is a possibility of plasticity and cortical reorganization of the cortical region. Impairment of the CST and deep white fibers may be more critical and irreversible in the Rolandic area. However, production of a uniform image is sometimes difficult with DTI and fMRI because of various methodological limitations [10]. The imaging results may differ between institutions and the type