Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes-A Retrospective Study of 25 Cases.
Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes-A Retrospective Study of 25 Cases.
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脑动力畸形破裂：手术时机和结局 - 对25例的回顾性研究。
DOI：
10.1055/s-0040-1716792
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发表时间：
2021-01
影响因子：
1.4
通讯作者：
Delfini R
中科院分区：
文献类型：
--
作者：
Di Bartolomeo A;Scafa AK;Giugliano M;Dugoni DE;Ruggeri AG;Delfini R
背景 脑动静脉畸形破裂治疗的一个重要问题是手术时机的选择。这项研究的目的是了解哪些参数对手术时机和结果影响最大。材料与方法 自2010年1月至2018年12月，我所共收治25例脑动静脉畸形破裂患者。脑出血(ICH)评分用于评估出血严重程度，Spetzler-Martin评分用于AVM的构筑。我们将患者分为两组：“早期手术”和“延迟手术”。采用改良朗金评定量表(MRS)进行疗效评定。结果早期手术组11例，年龄38±18岁，格拉斯哥昏迷评分7.64±2.86， 评分2.82±0.71，血肿量45.55±23.21mL。出血起源于幕下占27.3%，AVM分级I~II级占82%，III级占9%，IV级占9%。术后3个月优良率为36.4%，1年后优良率为54.5%。延迟手术组14例，年龄41±16岁，GCS 13.21±2.39，ICH评分1.14±0.81，血肿量29.89±21.33mL。出血起源于幕下占14.2%，AVM分级I~II级占50%，III级占50%。术后3个月优良率为78.6%，1年后优良率为92.8%。结论 评分对早期预后影响较大，而对延迟预后影响较大。这些结果表明，最好在休息一段时间后进行手术，尽可能远离出血。此外，本研究还提示，对于脑出血评分高、动静脉畸形分级低的年轻患者，早期手术似乎是一种有效和可行的治疗策略。
Background One important problem in treatment of ruptured brain arteriovenous malformations (bAVMs) is surgical timing. The aim of the study was to understand which parameters affect surgical timing and outcomes the most. Materials and Methods Between January 2010 and December 2018, 25 patients underwent surgery for a ruptured bAVM at our institute. Intracerebral hemorrhage (ICH) score was used to evaluate hemorrhage severity, while Spetzler-Martin scale for AVM architecture. We divided patients in two groups: “early surgery” and “delayed surgery.” The modified Rankin Scale (mRS) evaluated the outcomes. Results Eleven patients were in the “early surgery” group: age 38 ± 18 years, Glasgow Coma Scale (GCS) 7.64 ± 2.86, ICH score 2.82 ± 0.71, hematoma volume 45.55 ± 23.21 mL. Infratentorial origin of hemorrhage was found in 27.3% cases; AVM grades were I to II in 82%, III in 9%, and IV in 9% cases. Outcome at 3 months was favorable in 36.4% cases and in 54.5% after 1 year. Fourteen patients were in the “delayed surgery” group: age 41 ± 16 years, GCS 13.21 ± 2.39, ICH score 1.14 ± 0.81, hematoma volume 29.89 ± 21.33 mL. Infratentorial origin of hemorrhage was found in 14.2% cases; AVM grades were I to II in 50% and III in 50%. Outcome at 3 months was favorable in 78.6% cases and in 92.8% after 1 year. Conclusions The early outcome is influenced more by the ICH score, while the delayed outcome by Spetzler-Martin grading. These results suggest that it is better to perform surgery after a rest period, away from the hemorrhage when possible. Moreover, this study suggests how in young patient with a high ICH score and a low AVM grade, early surgery seems to be a valid and feasible therapeutic strategy.
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影响因子：
8.3
作者：
Hemphill, JC;Bonovich, DC;Johnston, SC
通讯作者：
Johnston, SC
影响因子：
8.3
作者：
Hartmann, A;Pile-Spellman, J;Mast, H
通讯作者：
Mast, H
影响因子：
11.2
作者：
TUHRIM, S;DAMBROSIA, JM;KASE, CS
通讯作者：
KASE, CS
影响因子：
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作者：
Deng, Zhenghai;Chen, Yu;Zhao, Jizong
通讯作者：
Zhao, Jizong
影响因子：
4.1
作者：
FORSTER, DMC;STEINER, L;HAKANSON, S
通讯作者：
HAKANSON, S