The Diagnosis and Management of Brain Arteriovenous Malformations in a Single Regional Center
The Diagnosis and Management of Brain Arteriovenous Malformations in a Single Regional Center
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DOI：
10.1016/j.wneu.2015.06.017
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发表时间：
2015-12-01
影响因子：
2
通讯作者：
St George, E. Jerome
中科院分区：
文献类型：
--
作者：
Young, Adam M. H.;Teo, Mario;St George, E. Jerome
背景：脑动静脉畸形是一种通过实质内异常的血管网络(NIDU)发生动静脉分流的血管畸形。这些病变通常在30岁时出现脑出血、癫痫发作、头痛或神经功能障碍，但有时是偶然发现的。方法：对7年间涉及单个区域中心的颅内动静脉畸形进行回顾性分析，以回顾2005年1月至2012年12月的临床表现、病理特征和治疗结果。结果：我们确定了142例患者(女性56%，年龄4-69岁)。急诊转诊占队列的87%，最常见的表现是头痛和/或出血。超过一半(52%)的病例在检查时发现有神经功能缺陷。Spetzler-Martin分级为3级，76%位于健脑区，57%位于优势半球。一半的病例有多条供血血管，29%的病例与动脉瘤有关。在积极治疗的病例中，91%的病例病灶完全消失。三分之二的患者成功地通过单一方式治疗，最常见的是栓塞术。保守治疗仅占8%。此外，93%已确诊的动脉瘤得到了成功治疗。并发症发生率为7%，占报告感染的2%。结论：随着急诊转诊次数的增加，动静脉畸形管理的负担明显增加。有趣的是，在未破裂的队列中，并发症发生率更高。手术治疗是最有效的方法，但其并发症发生率最高。随之而来的是动静脉畸形解剖和相关病理学的挑战，需要在一个中心提供专家服务。
BACKGROUND: Cerebral arteriovenous malformations are vascular abnormalities in which arteriovenous shunting occurs through an abnormal vascular network (nidus) in the parenchyma. These lesions typically present by the third decade of life with cerebral bleeding, seizures, headache, or neurologic deficits; however, they are sometimes found incidentally.METHODS: A retrospective analysis of intracranial AVMs referred to a single regional center, over a 7-year period, was performed to review the clinical presentation, pathologic features and management outcomes from January 2005 to December 2012.RESULTS: We identified 142 patients (56% female, age range 4-69 years). Emergency referrals accounted for 87% of the cohort with the most frequent presentation being headache and/or hemorrhage. More than half (52%) of the cases were observed to have a neurologic deficit on examination. The modal Spetzler-Martin Grade was 3 with 76% of lesions located in areas of eloquent brain and 57% of cases in the dominant hemisphere. Half of the cases had multiple feeder vessels, and 29% were associated with aneurysms. The nidus was obliterated in 91% of cases actively managed. Two thirds of patients were successfully treated with a single modality, the most common being embolization. Only 8% of cases were managed conservatively. Additionally, 93% of aneurysms identified were treated successfully. The complication rate was 7% with 2% of reported infection.CONCLUSIONS: The burden of AVM management is significantly enhanced by the number of emergency referrals. Interestingly, complication rates are higher in the unruptured cohort. Surgical management is the most effective modality, but it carries the highest complication rate. This accompanied by the challenges of AVM anatomy and associated pathology argue for expert service provision in a single center.