目的:本研究的目的是评估动静脉畸形(AVM)显微手术切除后的功能结果,并比较符合该手术系列未破裂脑动静脉畸形随机试验的患者的结果与报告的结果和ARUBA研究。
方法:我们回顾了2016年1月至2021年12月在我们机构接受动静脉畸形(AVM)显微外科治疗的169例患者的记录。在末次随访和治疗前使用改良的Rankin量表(mRS)评分评估这些患者的功能状态。最新随访时的mRS评分分为良好结局(mRS<3)和不良结局(mRS≥3)。临床表现,患者人口统计学,AVM特性,随访时间,并对消失率进行了分析。对整个队列进行亚组分析,比较Spetzler-Martin一级和二级,和符合ARUBA标准的AVM。
结果:在169例患者中,有71例(42%)出现了初始出血表现。大多数患者出现头痛(73%)。166例(98.2%)患者的AVM完全消失。该系列包括65个Spetzler-MartinI级(38.5%),46二级(27.2%),32三级(18.9%),22四级(13%),和4例V级(2.4%)AVM。有98例未破裂和79例符合ARUBA标准的病例。此外,145例(85.8%)患者实现了最佳功能结局.总死亡率为5.3%(9/169)。多变量分析表明,不良结局与术前mRS≥3显着相关(p<0.013;OR,0.206;95%CI0.059-0.713),年龄增加(p<0.045;比值比[OR],1.022;95%CI1.000-0.045),和女性(p<0.009;或,2.991;95%CI1.309-6.832)。
结论:我们的研究表明,大多数AVM患者使用显微外科手术切除可以获得更好的结果。AVM手术切除后不良结果的独立预测因素包括手术时年龄增加,不良的术前功能状态,和女性性别。假设患者在术前检查后更适合显微手术,该病例的结局通常优于多模式干预(如保守治疗或ARUBA治疗组).因此,我们建议对所有手术可触及的AVM进行早期手术切除,以防止连续出血和神经系统预后不良的后果.
OBJECTIVE: The purpose of the study was to assess the functional outcomes after microsurgical resection of arteriovenous malformations (AVMs) and to compare the results between patients eligible for A Randomized Trial of Unruptured Brain Arteriovenous Malformations in this surgical series to the results reported and the ARUBA study.
METHODS: We reviewed the records of 169 patients who underwent microsurgical treatment of arteriovenous malformation (AVMs) in our institution between January 2016 and December 2021. These patients\' functional status was assessed using modified Rankin Scale (mRS) scores at the last follow-up and before treatment. The mRS scores at the latest follow-up were classified into good outcomes (mRS < 3) and poor outcomes (mRS ≥ 3). Clinical presentation, patients\' demographics,
AVM characteristics, follow-up time, and obliteration rate were analyzed. Subgroup analyses were performed on the whole cohort, comparing Spetzler-Martin Grade I and Grade II, and ARUBA-eligible AVMs.
RESULTS: The initial hemorrhagic presentation occurred in 71 (42%) out of 169 patients. The majority of the patients presented with headaches (73%). The AVMs were completely obliterated in 166 (98.2%) patients. The series included 65 Spetzler-Martin Grade I (38.5%), 46 Grade II (27.2%), 32 Grade III (18.9%), 22 Grade IV (13%), and 4 Grade V (2.4%) AVMs. There were 98 unruptured and 79 ARUBA-eligible cases. Also, optimal functional outcome was achieved in 145 (85.8%) patients. The overall mortality rate was 5.3% (9/169). The multivariate analysis illustrated that a poor outcome was significantly associated with presurgical mRS ≥3 (p < 0.013; OR, 0.206; 95% CI 0.059-0.713), increasing age (p < 0.045; odds ratio [OR], 1.022; 95% CI 1.000-0.045), and female gender (p < 0.009; OR, 2.991; 95% CI 1.309-6.832).
CONCLUSIONS: Our study suggests that better outcomes can be obtained using microsurgical resection in the majority of patients with AVMs. Independent predictors of poor outcomes after surgical resection of AVMs include increasing age at the time of surgery, poor presurgical functional status, and female gender. Supposing that patients are more suitable for microsurgery after presurgical examination, outcomes are normally better in that case than those achieved by multimodal interventions (such as conservative treatment or ARUBA treatment arm). Therefore, we recommend early surgical removal on all surgically accessible AVMs to prevent successive hemorrhages and the consequences of poor neurological outcomes.