Deep arteriovenous malformations in the basal ganglia, thalamus, and insula: multimodality management, patient selection, and results.
Deep arteriovenous malformations in the basal ganglia, thalamus, and insula: multimodality management, patient selection, and results.
复制标题
基底神经节，丘脑和岛状的深静脉畸形：多模式管理，患者选择和结果。
DOI：
10.1016/j.wneu.2014.03.033
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发表时间：
2014-09
影响因子：
2
通讯作者：
Lawton, Michael T.
中科院分区：
文献类型：
--
作者：
Potts, Matthew B.;Jahangiri, Arman;Jen, Maxwell;Sneed, Penny K.;McDermott, Michael W.;Gupta, Nalin;Hetts, Steven W.;Young, William L.;Lawton, Michael T.
描述单一机构在多模式融合中治疗基底节、丘脑和小脑动静脉畸形（AVM）的经验。我们对1997 - 2011年间在我们机构治疗的所有深部AVM进行了回顾性审查，关注患者选择、治疗策略以及影像学和功能结局。97例患者在我们机构接受了初步治疗。64%出现出血。29%位于基底节，41%位于丘脑，30%位于丘脑。80%为Spetzler-Martin III-IV级。初步治疗为显微手术切除42%，立体定向放射外科（SRS）45%，观察12%。初次手术或SRS治疗后影像学治愈率为54%（分别为71%和23%），后续治疗后为63%，78%的患者功能结局良好（中位随访时间为2.2年）。多变量逻辑回归分析显示，治疗组和年龄是与放射学治愈相关的因素，而Spetzler-Martin评分和随访时间与最后一次随访时功能状态的改善/不变显着相关。11%的患者发生了治疗后出血（7%的手术患者和18%的SRS患者）。深部AVM的现代治疗包括采用显微手术、SRS、栓塞和观察的多学科方法。补充分级在传统Spetzler-Martin分级的基础上增加了有意义的内容，以指导患者选择。与SRS相比，手术切除更可能导致闭塞，并且在高度选择的患者中与满意的结果相关。
To describe a single institution’s experience treating arteriovenous malformations (AVMs) of the basal ganglia, thalamus, and insula in a multimodal fasion. We conducted a retrospective review of all deep AVMs treated at our institution between 1997–2011 with attention to patient selection, treatment strategies, and radiographic and functional outcomes. 97 patients underwent initial treatment at our institution. 64% presented with hemorrhage. 29% were located in the basal ganglia, 41% in the thalamus, and 30% in the insula. 80% were Spetzler-Martin grade III-IV. Initial treatment was microsurgical resection in 42%, stereotactic radiosurgery (SRS) in 45%, and observation in 12%. Radiographic cure was achieved in 54% after initial surgical or SRS treatment (71% and 23%, respectively) and in 63% after subsequent treatments, with good functional outcomes in 78% (median follow-up 2.2 years). Multivariate logistic regression analysis revealed treatment group and age as factors associated with radiographic cure, while Spetzler-Martin score and time to follow-up were significantly associated with improved/unchanged functional status at time of last follow-up. Post-treatment hemorrhage occurred in 11% (7% of surgical and 18% of SRS patients). Modern treatment of deep AVMs includes a multidisciplinary approach utilizing microsurgery, SRS, embolization, and observation. Supplementary grading adds meaningfully to traditional Spetzler-Martin grading to guide patient selection. Surgical resection is more likely to result in obliteration compared to SRS, and is associated with satisfactory results in highly selected patients.
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影响因子：
4.1
作者：
Kano, Hideyuki;Kondziolka, Douglas;Lunsford, L. Dade
通讯作者：
Lunsford, L. Dade
影响因子：
4.8
作者：
Lawton, MT;Golfinos, JG;Spetzler, RF
通讯作者：
Spetzler, RF
影响因子：
4.8
作者：
Potts, Matthew B.;Chang, Edward F.;Lawton, Michael T.
通讯作者：
Lawton, Michael T.
影响因子：
4.8
作者：
SHUCART, WA;STEIN, BM
通讯作者：
STEIN, BM
影响因子：
5.7
作者：
Flickinger, JC;Kondziolka, D;Lunsford, LD
通讯作者：
Lunsford, LD