Hemorrhage Following Complete Arteriovenous Malformation Resection With No Detectable Recurrence: Insights From a 27-Year Registry
Hemorrhage Following Complete Arteriovenous Malformation Resection With No Detectable Recurrence: Insights From a 27-Year Registry
复制标题
动静脉畸形完全切除术后出血且未检测到复发：来自 27 年登记的见解
作者：
Sarah Rapaport;James Feghali;Wuyang Yang;Abhishek Gami;J. Patel;R. Tamargo;J. Caplan;Judy Huang
摘要背景尽管有报道称动静脉畸形（AVM）在完全切除后会复发和重新形成，但显微手术后在AVM的同一位置发生出血而无可检测到的病变（病变阴性出血）尚未报道。目的描述完全显微手术切除后病变阴性出血的发生率和特性。方法使用了1990年至2017年期间在我们机构观察的AVM患者的前瞻性登记研究。选择经显微手术治疗的患者，计算病灶阴性出血的发生率，并用Kaplan-Meier曲线描述。比较了有和无病变阴性出血患者的基线特征以及末次随访时的功能结局。结果：在总共789例AVM患者中，619例（79%）接受了治疗，其中210例（34%）接受了显微外科手术（有或无术前栓塞或放射外科手术）。显微手术治疗的队列在术后平均随访6.1 ± 3.0年，5例（2.4%）患者在术后平均8.6 ± 9.0年发生切除后病变阴性出血（3.9/1000人-年）。出血后（出血后2个月）的随访血管造影证实所有病例均无复发或新发AVM。所有病灶阴性出血的患者在切除术前最初均出现破裂（Fisher P = 0.066;对数秩P = 0.057）。病变阴性出血的发生与末次随访时改良兰金量表评分较差显著相关（P = 0.031）。结论：在2.4%的患者中，完全显微手术切除后可能发生病变阴性出血。探索可能的根本原因是必要的。
Abstract BACKGROUND Although recurrence and de novo formation of arteriovenous malformations (AVMs) have been reported following complete resection, the occurrence of hemorrhage in the same location of an AVM with no detectable lesion (lesion-negative hemorrhage) has not been described after microsurgery. OBJECTIVE To characterize the incidence and properties of lesion-negative hemorrhage following complete microsurgical resection METHODS A prospectively maintained registry of AVM patients seen at our institution between 1990 and 2017 was used. Microsurgically treated patients were selected, and the incidence of a lesion-negative hemorrhage was calculated and described with a Kaplan-Meier curve. Baseline characteristics as well as functional outcome at last follow-up were compared between patients with and without a lesion-negative hemorrhage. RESULTS From a total of 789 AVM patients, 619 (79%) were treated, and 210 out of 619 patients (34%) underwent microsurgery with or without preoperative embolization or radiosurgery. The microsurgically treated cohort was followed up for a mean of 6.1 ± 3.0 yr after surgery with 5 (2.4%) patients experiencing postresection lesion-negative hemorrhage (3.9 per 1000 person-years) at an average of 8.6 ± 9.0 yr following surgery. Follow-up angiograms after hemorrhage (up to 2 mo posthemorrhage) confirmed the absence of a recurrent or de novo AVM in all cases. All patients with a lesion-negative hemorrhage initially presented with rupture before resection (Fisher P = .066; log-rank P = .057). The occurrence of a lesion-negative hemorrhage was significantly associated with worse modified Rankin scale scores at last follow-up (P = .031). CONCLUSION A lesion-negative hemorrhage can occur following complete microsurgical resection in up to 2.4% of patients. Exploration of possible underlying causes is warranted.