Mansmann U, Meisel J, Brock M, Rodesch G, Alvarez H, Lasjaunias P
Department of Medical Statistics, Epidemiology, and Informatics, Klinikum Benjamin Franklin, Free University Berlin, Germany.
Neurosurgery. 2000 Feb;46(2):272-9; discussion 279-81. doi: 10.1097/00006123-200002000-00004.
The standard categorization of arteriovenous malformations (AVMs) involves the Spetzler-Martin grading system, which uses a simple analysis of size, location (superficial or deep), and the presence of deep or superficial drainage. Hemodynamic risk factors are also thought to play important roles in the pathogenesis of these lesions and to be associated with the intracranial hemorrhage (ICH) rate. The actual hemodynamic factors for AVMs cannot be easily measured, but angioarchitectural features can be assessed and used as surrogate parameters.
The AVM angioarchitectural features for 662 patients were analyzed, and their associations with ICH as a presenting sign were studied. A cross-sectional analysis was used to qualify the strength of associations among clinical features, angioarchitectural characteristics, and ICH before treatment.
The multivariate analysis indicated that arterial stenosis and arterial ectasia were associated with lower ICH rates, whereas venous stenosis increased the rate of ICH. The presence of angiogenesis modified the effects of arterial and venous stenosis. Furthermore, the effect of venous stenosis depended on the location of the nidus. The presented data do not support a direct positive association between associated aneurysms and ICH.
Certain angiographic features seem to have prognostic potential with respect to the occurrence of ICH among patients with AVMs. A discriminatory prognostic index is proposed; its relevance must be proven in a future prospective study.
动静脉畸形（AVM）的标准分类采用斯佩茨勒 - 马丁分级系统，该系统对大小、位置（浅表或深部）以及深部或浅表引流情况进行简单分析。血流动力学危险因素也被认为在这些病变的发病机制中起重要作用，并与颅内出血（ICH）发生率相关。AVM的实际血流动力学因素不易测量，但血管构筑特征可以评估并用作替代参数。
分析了662例患者的AVM血管构筑特征，并研究了它们与以ICH为首发症状的相关性。采用横断面分析来确定治疗前临床特征、血管构筑特征和ICH之间关联的强度。
多变量分析表明，动脉狭窄和动脉扩张与较低的ICH发生率相关，而静脉狭窄则增加了ICH发生率。血管生成的存在改变了动脉和静脉狭窄的影响。此外，静脉狭窄的影响取决于畸形灶的位置。所呈现的数据不支持相关动脉瘤与ICH之间存在直接正相关。
某些血管造影特征似乎对AVM患者ICH的发生具有预后潜力。提出了一个鉴别预后指数；其相关性必须在未来的前瞻性研究中得到证实。
