Recurrence of Cerebral Arteriovenous Malformations Following Resection in Adults: Does Preoperative Embolization Increase the Risk?
Recurrence of Cerebral Arteriovenous Malformations Following Resection in Adults: Does Preoperative Embolization Increase the Risk?
复制标题
DOI：
10.1227/neu.0000000000001191
复制
发表时间：
2016-04-01
期刊：
影响因子：
4.8
通讯作者：
Amin-Hanjani, Sepideh
中科院分区：
文献类型：
--
作者：
Ivanov, Alexander A.;Alaraj, Ali;Amin-Hanjani, Sepideh
背景技术背景：通过术后血管造影证实的动静脉畸形（AVM）的完全手术切除通常被认为代表治愈，无需长期随访成像。虽然在儿科人群中报告了AVM复发，但在成人中很少记录这种现象。然而，单纯栓塞治疗后复发的报道更为频繁。因此，患者接受多模式治疗与术前栓塞手术后，也可能是在较高的风险reproduction.OBJECTIVE：要确定术前栓塞有助于复发的AVM后完全手术切除术。那些完全手术切除AVM的患者，经术后早期脑血管造影阴性证实，并在术后6个月内进行了可用的随访血管造影成像。72例患者符合合格标准。复发3例（4%）。深静脉引流和弥漫型AVM病灶与复发显著相关。虽然术前栓塞没有达到统计学意义作为一个独立的风险因素，放射学数据支持其在每一个案件中的作用，与复发的网站与深部区域的病灶以前闭塞的embolization.CONCLUSION：AVM复发在成人人群中可能有一个多因素的起源。尽管深静脉引流和弥漫性病灶是明显的风险因素，但术前栓塞也可能是导致AVM未切除但栓塞部分复发的潜在因素。随访血管造影在1至3年似乎是必要的。
BACKGROUND: Complete surgical resection of arteriovenous malformations (AVMs), documented by postoperative angiography, is generally felt to represent cure, obviating the need for long-term follow-up imaging. Although AVM recurrence has been reported in the pediatric population, this phenomenon has only rarely been documented in adults. Recurrence after treatment solely with embolization, however, has been reported more frequently. Thus, patients undergoing multimodal therapy with surgery following preoperative embolization may also be at higher risk for recurrence.OBJECTIVE: To determine if preoperative embolization contributes to recurrences of AVMs after complete surgical resection.METHODS: A retrospective study of patients undergoing AVM resection was performed. Those with complete surgical AVM resection, confirmed by negative early postoperative cerebral angiography and with available follow-up angiographic imaging >6 months postoperatively were included.RESULTS: Two hundred three patients underwent AVM resection between 1995 and 2012. Seventy-two patients met eligibility criteria. There were 3 recurrences (4%). Deep venous drainage and diffuse type of AVM nidus were significantly associated with recurrence. Although preoperative embolization did not reach statistical significance as an independent risk factor, radiographic data supported its role in every case, with the site of recurrence correlating with deep regions of nidus previously obliterated by embolization.CONCLUSION: AVM recurrences in the adult population may have a multifactorial origin. Although deep venous drainage and diffuse nidus are clearly risk factors, preoperative embolization may also be a contributing factor with the potential for recurrence of unresected but embolized portions of the AVM. Follow-up angiography at 1 to 3 years appears to be warranted.