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Abstract：
BACKGROUND: Posterior fossa arterio-venous malformations (pfAVMs) are challenging lesions due to the anatomical particularities of the posterior fossa, and the high incidence of hemorrhagic presentation. The two most important goals when treating AVMs are preserving neurological function and preventing rupture, or a second hemorrhage. The aim of this study was to analyze the clinical and imaging features of pfAVMs to identify the factors that influence the prognosis of these patients.
METHODS: We conducted a single-center retrospective observational study that included patients treated at our institution with pfAVMs between January 1997 and December 2021.
RESULTS: A total of 48 patients were included. A good modified Rankin score (mRS) was observed in 33 cases (69%) at presentation. Thirty-four patients (71%) presented with a ruptured AVM. Out of these, 19 patients (40%) had intraventricular hemorrhage. Microsurgical resection was performed in 33 cases (69%), while in the other cases, the patients opted for conservative management (7 cases, 15%), stereotactic radiosurgery (SRS) (6 cases, 12%), or endovascular treatment (2 cases, 4%). Patients ≤ 30 years old were more prone to hemorrhagic presentation (OR: 5.23; 95% CI: 1.42-17.19; p = 0.024) and this remained an independent risk factor for rupture after multivariate analysis as well (OR: 4.81; 95% CI: 1.07-21.53; p = 0.040). Following multivariate analysis, the only factor independently associated with poor prognosis in the surgically treated subgroup was a poor clinical status (mRS 3-5) at admission (OR: 96.14; 95% CI: 5.15-1793.9; p = 0.002).
CONCLUSIONS: Management of posterior fossa AVMs is challenging, and patients who present with ruptured AVMs often have a poor clinical status at admission leading to a poor prognosis. Therefore, proper and timely management of these patients is essential.
METHODS: We conducted a single-center retrospective observational study that included patients treated at our institution with pfAVMs between January 1997 and December 2021.
RESULTS: A total of 48 patients were included. A good modified Rankin score (mRS) was observed in 33 cases (69%) at presentation. Thirty-four patients (71%) presented with a ruptured AVM. Out of these, 19 patients (40%) had intraventricular hemorrhage. Microsurgical resection was performed in 33 cases (69%), while in the other cases, the patients opted for conservative management (7 cases, 15%), stereotactic radiosurgery (SRS) (6 cases, 12%), or endovascular treatment (2 cases, 4%). Patients ≤ 30 years old were more prone to hemorrhagic presentation (OR: 5.23; 95% CI: 1.42-17.19; p = 0.024) and this remained an independent risk factor for rupture after multivariate analysis as well (OR: 4.81; 95% CI: 1.07-21.53; p = 0.040). Following multivariate analysis, the only factor independently associated with poor prognosis in the surgically treated subgroup was a poor clinical status (mRS 3-5) at admission (OR: 96.14; 95% CI: 5.15-1793.9; p = 0.002).
CONCLUSIONS: Management of posterior fossa AVMs is challenging, and patients who present with ruptured AVMs often have a poor clinical status at admission leading to a poor prognosis. Therefore, proper and timely management of these patients is essential.
摘要：
背景：由于后颅窝的解剖学特殊性，后颅窝动静脉畸形（pfAVM）是具有挑战性的病变，以及出血性表现的高发生率。治疗AVM最重要的两个目标是保护神经功能和防止破裂。或者第二次出血.这项研究的目的是分析pfAVM的临床和影像学特征，以确定影响这些患者预后的因素。
方法：我们进行了一项单中心回顾性观察性研究，包括1997年1月至2021年12月在我们机构接受pfAVM治疗的患者。
结果：共纳入48例患者。33例（69％）在就诊时观察到良好的改良Rankin评分（mRS）。34例患者（71％）出现AVM破裂。在这些中，19例(40%)患者发生脑室内出血。33例（69％）进行了显微外科手术切除，而在其他情况下，患者选择保守治疗(7例，15%），立体定向放射外科（SRS）（6例，12%），或血管内治疗（2例，4%)。年龄≤30岁的患者更容易出现出血（OR：5.23；95％CI：1.42-17.19；p=0.024），在多变量分析后，这仍然是破裂的独立危险因素（OR：4.81；95％CI：1.07-21.53；p=0.040）。在多变量分析之后，在接受手术治疗的亚组中,与不良预后独立相关的唯一因素是入院时的不良临床状态(mRS3-5)(OR:96.14;95%CI:5.15-1793.9;p=0.002).
结论：后颅窝AVM的治疗具有挑战性，并且存在AVM破裂的患者在入院时的临床状态通常较差，从而导致预后不良。因此,对这些患者进行适当和及时的管理至关重要。
方法：我们进行了一项单中心回顾性观察性研究，包括1997年1月至2021年12月在我们机构接受pfAVM治疗的患者。
结果：共纳入48例患者。33例（69％）在就诊时观察到良好的改良Rankin评分（mRS）。34例患者（71％）出现AVM破裂。在这些中，19例(40%)患者发生脑室内出血。33例（69％）进行了显微外科手术切除，而在其他情况下，患者选择保守治疗(7例，15%），立体定向放射外科（SRS）（6例，12%），或血管内治疗（2例，4%)。年龄≤30岁的患者更容易出现出血（OR：5.23；95％CI：1.42-17.19；p=0.024），在多变量分析后，这仍然是破裂的独立危险因素（OR：4.81；95％CI：1.07-21.53；p=0.040）。在多变量分析之后，在接受手术治疗的亚组中,与不良预后独立相关的唯一因素是入院时的不良临床状态(mRS3-5)(OR:96.14;95%CI:5.15-1793.9;p=0.002).
结论：后颅窝AVM的治疗具有挑战性，并且存在AVM破裂的患者在入院时的临床状态通常较差，从而导致预后不良。因此,对这些患者进行适当和及时的管理至关重要。
