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.
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。