A population-based study of brain arteriovenous malformation - Long-term treatment outcomes
A population-based study of brain arteriovenous malformation - Long-term treatment outcomes
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DOI：
10.1161/01.str.0000043674.99741.9b
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发表时间：
2002-12-01
期刊：
影响因子：
8.3
通讯作者：
Popovic, EA
中科院分区：
文献类型：
--
作者：
ApSimon, HT;Reef, H;Popovic, EA
背景和目的-通过对一个功能隔离的人群研究组进行长期跟踪，我们试图获得内在脑动静脉畸形(BAVM)的真实情况。我们试图评估早期以人群为基础的系列研究的有效性，并确定新的治疗方法对BAVM总体发病率和死亡率的影响。结果：全组病死率为12.9%，全组病死率为8.75%，保守治疗组病死率为24.6%，积极治疗病死率为3.9%(P=0.031)。诊断至死亡的平均间隔时间为10.6年。209名幸存者(2001年7月)的牛津神经功能障碍评定量表评分如下：0~2级占74.1%，3级占17.2%，4~5级占9.5%。最初出现出血或出现非出血性神经功能障碍的患者死亡率较高。首次出血发生率：0~9岁为4.6%(P=0.0035)，30~39岁为21%(P=0.02)，60~69岁为40.0%(P=0.045)。首次出血的致死率为4.6%。结论：我们没有发现大量未诊断的无症状性脑动静脉畸形的证据。所有的脑动静脉畸形都有潜在的危险。绝大多数的脑动静脉畸形患者在患者的一生中会出现症状，大多数会出血。首次出血的风险是终生的，并且随着年龄的增长而增加。与早期以人群为基础的系列相比，我们的低总体患者死亡率主要是由于在20世纪80年代和90年代积极治疗的比例较高。
Background and Purpose-By undertaking long-term follow-up of a functionally isolated population study group, we sought to achieve a true picture of intrinsic brain arteriovenous malformation (BAVM). We sought to assess the validity of earlier population-based series and to determine the effects of newer treatment methods on the overall morbidity and mortality of BAVM.Methods-We excluded other intracranial vascular pathologies by defining criteria. By retrospective and prospective study, 240 patients with BAVM were followed for a mean of 10.11 years from first diagnosis.Results-Death rates were as follows: all causes, 12.9%; all BAVM related, 8.75%; BAVM related during conservative management, 24.6%; and BAVM related during active management, 3.9% (P=0.031). Mean diagnosis-to-death interval was 10.6 years. Oxford neurological disability scale grades of 209 survivors (July 2001) were as follows: grades 0 to 2, 74.1%; grade 3, 17.2%; and grades 4 to 5, 9.5%. Death rates were higher for patients who had bled or suffered nonhemorrhagic neurological deficit at original presentation. Incidence of first-ever hemorrhage in untreated patients was as follows: 0 to 9 years, 4.6% (P=0.0035); 30 to 39 years, 21% (P=0.02); and 60 to 69 years, 40.0% (P=0.045). The first bleed was fatal in 4.6%.Conclusions-We find no evidence of a substantial undiagnosed reservoir of nonsymptomatic BAVM. All BAVM are potentially hazardous. The great majority of BAVM patients become symptomatic during the patient's lifetime, and the majority will bleed. The risk of first hemorrhage is lifelong and rises with age. Compared with earlier population-based series, our low overall patient mortality is predominantly due to higher proportions of active treatment in the 1980s and 1990s.