Multimodality management of Spetzler-Martin Grade III arteriovenous malformations
Multimodality management of Spetzler-Martin Grade III arteriovenous malformations
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DOI：
10.3171/2012.3.jns111575
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发表时间：
2012-06-01
影响因子：
4.1
通讯作者：
Steinberg, Gary K.
中科院分区：
文献类型：
--
作者：
Pandey, Paritosh;Marks, Michael P.;Steinberg, Gary K.
Object. III级动静脉畸形（AVM）因其大小（S）、功能区皮质位置（E）和是否存在中心静脉引流（V）而多种多样。因为它们可能对管理和结果有影响，作者在本研究中评估了这些变化。1984年至2010年期间，100例III级AVM患者接受了治疗。根据Spetzler-Martin特征将AVM分类如下：1型= S1 E1 V1，2型= S2 E1 V0，3型= S2 E0 V1，4型= S3 E0 V0。出院和随访时新发神经功能缺损、功能状态（基于改良兰金量表[mRS]评分）和放射学闭塞的发生与人口统计学和形态学特征相关。对100例患者（49例女性和51例男性;年龄范围5-68岁，平均35.8岁）进行了评价。AVM直径小于3cm者28例，3- 6cm者71例，大于6cm者1例; 86例AVM位于功能区皮质，38例有中央引流。1型28例，2型60例，3型11例。I型4型。作者对77例患者（175例手术）进行了栓塞，对64例患者（74例手术）进行了外科手术，对49例患者（44例原发性和5例术后）进行了放射外科手术。14例患者（14%）有新的神经功能缺损，5例（5%）为致残性（mRS评分> 2），9例（9%）为非致残性（mRS评分> 3 cm），非出血性表现预测发生新的功能缺损（p= 3 cm），以解释治疗风险。(http：//thejns.org/doi/abs/10.3171/2012.3.JNS111575）
Object. Grade III arteriovenous malformations (AVMs) are diverse because of their variations in size (S), location in eloquent cortex (E), and presence of central venous drainage (V). Because they may have implications for management and outcome, the authors evaluated these variations in the present study.Methods. Between 1984 and 2010, 100 patients with Grade III AVMs were treated. The AVMs were categorized by Spetzler-Martin characteristics as follows: Type 1 = S1E1V1, Type 2 = S2E1V0, Type 3 = S2E0V1, and Type 4 = S3E0V0. The occurrence of a new neurological deficit, functional status (based on modified Rankin Scale [mRS] score) at discharge and follow-up, and radiological obliteration were correlated with demographic and morphological characteristics.Results. One hundred patients (49 female and 51 male; age range 5-68 years, mean 35.8 years) were evaluated. The size of AVMs was less than 3 cm in 28 patients, 3-6 cm in 71, and greater than 6 cm in 1; 86 AVMs were located in eloquent cortex and 38 had central drainage. The AVMs were Type 1 in 28 cases, Type 2 in 60, Type 3 in 11. and Type 4 in I. The authors performed embolization in 77 patients (175 procedures), surgery in 64 patients (74 surgeries), and radiosurgery in 49 patients (44 primary and 5 postoperative).The mortality rate following the management of these AVMs was 1%. Fourteen patients (14%) had new neurological deficits, with 5 (5%) being disabling (mRS score > 2) and 9 (9%) being nondisabling (mRS score 3 cm, and nonhemorrhagic presentation predicted the occurrence of new deficits (p= 3 cm) to account for treatment risk. (http://thejns.org/doi/abs/10.3171/2012.3.JNS111575)