Multimodal management of arteriovenous malformations of the basal ganglia and thalamus: factors affecting obliteration and outcome
Multimodal management of arteriovenous malformations of the basal ganglia and thalamus: factors affecting obliteration and outcome
复制标题
DOI：
10.3171/2018.2.jns172511
复制
发表时间：
2019-08-01
影响因子：
4.1
通讯作者：
Steinberg, Gary K.
中科院分区：
文献类型：
--
作者：
Madhugiri, Venkatesh S.;Teo, Mario K. C.;Steinberg, Gary K.
目的基底节和丘脑的动静脉畸形（AVM）是一种特别难治的病变，占手术治疗AVM的3%~ 13%，占放射外科畸形的23%~ 44%。本研究的目的是报告基底节和丘脑动静脉畸形的多模式管理的结果，并调查影响放射学治愈和良好的临床outcomes.METHODS的因素，这项研究是一个前瞻性的所有患者在作者的机构接受治疗的数据库的回顾性分析。分析了临床、影像学、随访和结局数据。进行单因素和多因素分析，探讨各种因素对outcome.RESULTS的结果和数据分析有关的123例患者治疗超过32年。在该队列中，50.9%的患者实现了放射学治愈。75%的患者有良好的临床结果（稳定或改善的性能评分），而25%的患者在治疗后恶化。纳入手术和放射外科独立预测闭塞，而病灶直径和体积预测临床结果。病灶体积/直径和手术的纳入预测了最佳结局，即，病变闭塞的临床结局良好。结论对这些复杂患者进行多模式治疗可能会取得良好的结局。增大的尺寸和更高的Spetzler-Martin分级与更差的结局相关。根据指征纳入多种治疗方式可以提高放射学治愈的机会和良好的结局。
OBJECTIVE Arteriovenous malformations (AVMs) of the basal ganglia and thalamus are particularly difficult lesions to treat, accounting for 3%-13% of all AVMs in surgical series and 23%-44% of malformations in radiosurgery series. The goal of this study was to report the results of multimodal management of basal ganglia and thalamic AVMs and investigate the factors that influence radiographic cure and good clinical outcomes.METHODS This study was a retrospective analysis of a prospectively maintained database of all patients treated at the authors' institution. Clinical, radiological, follow-up, and outcome data were analyzed. Univariate and multivariate analyses were conducted to explore the influence of various factors on outcome.RESULTS The results and data analysis pertaining to 123 patients treated over 32 years are presented. In this cohort, radiographic cure was achieved in 50.9% of the patients. Seventy-five percent of patients had good clinical outcomes (stable or improved performance scores), whereas 25% worsened after treatment. Inclusion of surgery and radiosurgery independently predicted obliteration, whereas nidus diameter and volume predicted clinical outcomes. Nidus volume/diameter and inclusion of surgery predicted the optimal outcome, i.e., good clinical outcomes with lesion obliteration.CONCLUSIONS Good outcomes are possible with multimodal treatment in these complex patients. Increasing size and, by extension, higher Spetzler-Martin grade are associated with worse outcomes. Inclusion of multiple modalities of treatment as indicated could improve the chances of radiographic cure and good outcomes.