ApSimon H T, Reef H, Phadke R V, Popovic E A
Interventional Neuroradiology Unit, Department of Neurology, Royal Perth Hospital, Perth, Western Australia.
Stroke. 2002 Dec;33(12):2794-800. doi: 10.1161/01.str.0000043674.99741.9b.
By undertaking long-term follow-up of a functionally isolated population study group, we sought to achieve a true picture of intrinsic brain arteriovenous malformation (BAVM). We sought to assess the validity of earlier population-based series and to determine the effects of newer treatment methods on the overall morbidity and mortality of BAVM.
We excluded other intracranial vascular pathologies by defining criteria. By retrospective and prospective study, 240 patients with BAVM were followed for a mean of 10.11 years from first diagnosis.
Death rates were as follows: all causes, 12.9%; all BAVM related, 8.75%; BAVM related during conservative management, 24.6%; and BAVM related during active management, 3.9% (P=0.031). Mean diagnosis-to-death interval was 10.6 years. Oxford neurological disability scale grades of 209 survivors (July 2001) were as follows: grades 0 to 2, 74.1%; grade 3, 17.2%; and grades 4 to 5, 9.5%. Death rates were higher for patients who had bled or suffered nonhemorrhagic neurological deficit at original presentation. Incidence of first-ever hemorrhage in untreated patients was as follows: 0 to 9 years, 4.6% (P=0.0035); 30 to 39 years, 21% (P=0.02); and 60 to 69 years, 40.0% (P=0.045). The first bleed was fatal in 4.6%.
We find no evidence of a substantial undiagnosed reservoir of nonsymptomatic BAVM. All BAVM are potentially hazardous. The great majority of BAVM patients become symptomatic during the patient's lifetime, and the majority will bleed. The risk of first hemorrhage is lifelong and rises with age. Compared with earlier population-based series, our low overall patient mortality is predominantly due to higher proportions of active treatment in the 1980s and 1990s.
通过对一个功能独立的人群研究组进行长期随访，我们试图全面了解脑内动静脉畸形（BAVM）的真实情况。我们旨在评估早期基于人群的系列研究的有效性，并确定新治疗方法对BAVM总体发病率和死亡率的影响。
我们通过定义标准排除了其他颅内血管病变。通过回顾性和前瞻性研究，对240例BAVM患者从首次诊断开始平均随访了10.11年。
死亡率如下：各种原因导致的死亡，12.9%；所有与BAVM相关的死亡，8.75%；保守治疗期间与BAVM相关的死亡，24.6%；积极治疗期间与BAVM相关的死亡，3.9%（P = 0.031）。从诊断到死亡的平均间隔时间为10.6年。209名幸存者（2001年7月）的牛津神经功能障碍量表分级如下：0至2级，74.1%；3级，17.2%；4至5级，9.5%。初次就诊时发生出血或非出血性神经功能缺损的患者死亡率更高。未经治疗患者首次出血的发生率如下：0至9岁，4.6%（P = 0.0035）；30至39岁，21%（P = 0.02）；60至69岁，40.0%（P = 0.045）。首次出血导致死亡的占4.6%。
我们没有发现大量未被诊断的无症状BAVM存在的证据。所有BAVM都有潜在危险。绝大多数BAVM患者在其一生中会出现症状，且大多数会出血。首次出血的风险是终身的，并随年龄增长而增加。与早期基于人群的系列研究相比，我们总体患者死亡率较低主要是因为20世纪80年代和90年代积极治疗的比例较高。
