Hartmann A, Stapf C, Hofmeister C, Mohr J P, Sciacca R R, Stein B M, Faulstich A, Mast H
New York Presbyterian Hospital, New York, NY, USA.
Stroke. 2000 Oct;31(10):2361-4. doi: 10.1161/01.str.31.10.2361.
We sought to define determinants of neurological deficit after surgery for brain arteriovenous malformation (AVM).
One hundred twenty-four prospective patients (48% women, mean age 33 years) underwent microsurgical brain AVM resection. Patients were examined by 3 study neurologists immediately before surgery, postoperatively in-hospital, by in-person long-term follow-up, and with a structured telephone follow-up. They were classified according to the 5-point Spetzler-Martin grading system, with its 3 elements: size, venous drainage pattern, and location. The functional neurological status was classified with the modified Rankin scale. Multivariate logistic regression models were applied to test the effect of patient age, gender, and the 3 Spetzler-Martin elements on early and long-term postoperative neurological complications.
Twelve patients (10%) were classified as Spetzler-Martin grade 1; 36 (29%) as grade 2; 47 (38%) as grade 3; 26 (21%) as grade 4; and 3 (2%) as grade 5. Postoperatively, in-hospital, 51 patients (41%) showed new neurological deficits (15% disabling [ie, Rankin scale score >2] and 26% nondisabling [ie, Rankin 1 or 2]). At long-term follow-up (mean follow-up time 12 months), 47 patients (38%) revealed surgery-related neurological deficits (6% disabling; 32% nondisabling). The rate of neurological complications increased by Spetzler-Martin grade. Female gender, AVM size, and deep venous drainage were significantly associated with neurological deficits at in-hospital and long-term evaluation. For patient age and AVM location, no significant association was found.
The findings suggest that female gender, AVM size, and AVM drainage into the deep venous system may be determinants of neurological deficit after microsurgical AVM resection.
我们试图明确脑动静脉畸形（AVM）手术后神经功能缺损的决定因素。
124例前瞻性患者（48%为女性，平均年龄33岁）接受了显微外科脑AVM切除术。3名研究神经科医生在手术前、术后住院期间、亲自进行长期随访以及通过结构化电话随访对患者进行检查。根据5分制斯佩茨勒 - 马丁分级系统对患者进行分类，该系统包含3个要素：大小、静脉引流模式和位置。采用改良Rankin量表对神经功能状态进行分类。应用多因素逻辑回归模型来检验患者年龄、性别以及斯佩茨勒 - 马丁分级系统的3个要素对术后早期和长期神经并发症的影响。
12例患者（10%）被分类为斯佩茨勒 - 马丁1级；36例（29%）为2级；47例（38%）为3级；26例（21%）为4级；3例（2%）为5级。术后住院期间，51例患者（41%）出现了新的神经功能缺损（15%为致残性缺损[即Rankin量表评分>2]，26%为非致残性缺损[即Rankin 1或2]）。在长期随访（平均随访时间12个月）时，47例患者（38%）出现了与手术相关的神经功能缺损（6%为致残性缺损；32%为非致残性缺损）。神经并发症的发生率随斯佩茨勒 - 马丁分级增加而升高。在住院期间和长期评估中，女性性别、AVM大小和深静脉引流与神经功能缺损显著相关。对于患者年龄和AVM位置，未发现显著相关性。
研究结果表明，女性性别、AVM大小以及AVM向深静脉系统的引流可能是显微外科AVM切除术后神经功能缺损的决定因素。
