Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases
Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases
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DOI：
10.3171/2014.7.focus14160
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发表时间：
2014-09-01
影响因子：
4.1
通讯作者：
Tjoumakaris, Stavropoula
中科院分区：
文献类型：
--
作者：
Theofanis, Thana;Chalouhi, Nohra;Tjoumakaris, Stavropoula
Object.作者进行了一项研究，以评估动静脉畸形（AVM）显微外科切除术的安全性和有效性，并确定并发症的预测因素。1994年至2010年期间，杰斐逊神经科学医院共对264例脑AVM患者进行了显微手术切除治疗。对患者数据进行了审查，包括初始出血、临床表现、Spetzler-Martin（SM）分级、治疗方式、临床结局和闭塞率。单因素和多因素分析用于确定手术并发症的预测因素。在接受显微手术治疗的264例患者中，120例（45%）患者最初出现出血。有27处SM I级病变（10.2%）、101处II级病变（38.3%）、96处III级病变（36.4%）、31处IV级病变（11.7%）和9处V级病变（3.4%）。在这些患者中，102例（38.6%）既往接受过血管内栓塞。在所有患者中，切除导致AVM完全闭塞。19例（7.2%）患者发生并发症，5例（1.9%）患者导致永久性神经功能缺损。在多变量分析中，并发症的预测因素是AVM尺寸增加（OR 3.2，95% CI 1.5-6.6; p = 0.001）、栓塞次数增加（OR 1.6，95% CI 1.1-2.2; p = 0.01）和未破裂AVM（OR 2.7，95% CI 1-7.2; p = 0.05）。AVM的显微手术切除是高效的，并且可以在高容量神经血管中心以低发病率进行。未破裂和较大的AVM与较高的并发症发生率相关。
Object. The authors conducted a study to assess the safety and efficacy of microsurgical resection of arteriovenous malformations (AVMs) and determine predictors of complications.Methods. A total of 264 patients with cerebral AVMs were treated with microsurgical resection between 1994 and 2010 at the Jefferson Hospital for Neuroscience. A review of patient data was performed, including initial hemorrhage, clinical presentation, Spetzler-Martin (SM) grade, treatment modalities, clinical outcomes, and obliteration rates. Univariate and multivariate analyses were used to determine predictors of operative complications.Results. Of the 264 patients treated with microsurgery, 120 (45%) patients initially presented with hemorrhage. There were 27 SM Grade I lesions (10.2%), 101 Grade II lesions (38.3%), 96 Grade III lesions (36.4%), 31 Grade IV lesions (11.7%), and 9 Grade V lesions (3.4%). Among these patients, 102 (38.6%) had undergone prior endovascular embolization. In all patients, resection resulted in complete obliteration of the AVM. Complications occurred in 19 (7.2%) patients and resulted in permanent neurological deficits in 5 (1.9%). In multivariate analysis, predictors of complications were increasing AVM size (OR 3.2, 95% CI 1.5-6.6; p = 0.001), increasing number of embolizations (OR 1.6, 95% CI 1.1-2.2; p = 0.01), and unruptured AVMs (OR 2.7, 95% CI 1-7.2; p = 0.05).Conclusions. Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of morbidity at high-volume neurovascular centers. Unruptured and larger AVMs were associated with higher complication rates.