One-Stage Surgical Resection of Giant Intracranial Arteriovenous Malformations in Selected Patients: A Novel Diffusion Tenser Imaging Score
One-Stage Surgical Resection of Giant Intracranial Arteriovenous Malformations in Selected Patients: A Novel Diffusion Tenser Imaging Score
复制标题
选定患者巨大颅内动静脉畸形的一期手术切除：一种新型的弥散张量成像评分
DOI：
10.1016/j.wneu.2019.07.075
复制
发表时间：
2019-10-01
影响因子：
2
通讯作者：
Lin，Yuanxiang
中科院分区：
文献类型：
--
作者：
Lin，Fuxin;Wu，Jun;Lin，Yuanxiang
巨大脑动静脉畸形（gAVM）的有效治疗具有挑战性。本研究的目的是确定1期切除gAVM的危险因素，并制定一个可靠的指标，为patientselection.MethodsA前瞻性维护数据库中的AVM患者在我们医院进行了审查。分析患者和病变的神经放射学表现和临床特征，以及术后功能缺损（FD）。建立了一种新的血氧水平依赖性功能磁共振成像评分和弥散张量成像（DTI）评分来预测手术结果。此外，在文献中的其他方法治疗gAVM的长期结果进行了review.ResultsA共35例患者35 gAVM。gAVM的平均直径为64.8 ± 4.9 mm。在单变量分析中，功能性磁共振成像评分（P= 0.022）和DTI评分（P= 0.003）均与长期FD显著相关。Spetzler-Martin评分（P= 0.092）趋向于显著性。多变量分析显示，高DTI评分（比值比，2.19; 95%置信区间，1.08-4.46;P= 0.030）是与长期FD相关的唯一独立危险因素。DTI评分的预测作用（曲线下面积= 0.822）上级Spetzler-Martin评分（曲线下面积= 0.640）根据受试者工作特性分析，临界点是2.5结论对于DTI评分较低（0-2分）的gAVM患者，一期手术切除gAVM是可行的。DTI评分可作为患者选择的可靠指标。
ObjectiveThe effective treatment of giant cerebral arteriovenous malformations (gAVMs) is challenging. The aim of this study was to determine the risk factors for 1-stage resection of gAVM and develop a reliable indicator for patient selection.MethodsA prospectively maintained database of patients with AVM in our hospital was reviewed. The neuroradiological findings and clinical characteristics of the patients and lesions were analyzed with respect to postoperative functional deficits (FD). A novel blood oxygen level–dependent functional magnetic resonance imaging score and a diffusion tensor imaging (DTI) score were created to predict surgical outcomes. Furthermore, the long-term outcomes of gAVMs treated by other methods in the literature were reviewed.ResultsA total of 35 patients with 35 gAVMs were included. The mean diameter of the gAVMs was 64.8 ± 4.9 mm. In the univariate analysis, the functional magnetic resonance imaging score (P= 0.022) and DTI score (P= 0.003) were both significantly associated with long-term FD. The Spetzler-Martin score (P= 0.092) trended toward significance. Multivariate analysis revealed that a high DTI score (odds ratio, 2.19; 95% confidence interval, 1.08–4.46;P= 0.030) was the only independent risk factor that was correlated with long-term FD. The predictive effect of the DTI score (area under the curve = 0.822) is superior to that of the Spetzler-Martin score (area under the curve = 0.640) according to the receiver operating characteristic analysis, and the cutoff point was 2.5 (sensitivity = 0.860 and specificity = 0.867).ConclusionsOne-stage surgical resection of gAVMs in patients with a low DTI score (0–2) seems to be feasible. The DTI score could be a reliable indicator for patient selection.