Spears Julian, Terbrugge Karel G, Moosavian Mona, Montanera Walter, Willinsky Robert A, Wallace M Christopher, Tymianski Michael
University of Toronto Brain Vascular Malformation Study Group, Toronto Western Hospital, Ontario, Canada.
Stroke. 2006 Jun;37(6):1457-64. doi: 10.1161/01.STR.0000222937.30216.13. Epub 2006 May 11.
To develop and validate a discriminative model for predicting neurological morbidity after brain arteriovenous malformation (bAVM) surgery.
Of 233 consecutive, prospectively enrolled patients undergoing bAVM surgery, the first 175 were used to derive, and the last 58 to validate, the prediction model. Demographic and angiographic factors were related to modified Rankin Scale scores assigned before, within 72 hours, at 7 days and at > or =1 year after surgery to seek predictors of postoperative neurological deficits (modified Rankin Scale score > or =3). These factors included nidus size, eloquence, venous drainage, diffuseness, white matter configuration, arterial perforator supply and associated aneurysms.
Brain eloquence, diffuse nidus and deep venous drainage were significant predictors of early disabling neurological deficits (odds ratios of 4.33, 3.49 and 2.38, respectively). The rounded odds ratios form a weighted 9-point prediction model (maximum scores for eloquence+diffuseness+deep drainage=4+3+2). The score discriminated the probability of experiencing both early (first week) and permanently (at > or =1 year) disabling neurological deficits as follows: 0 to 2: 1.8%, 3 to 5: 17.4%, 6 to 7: 31.6%, >7: 52.9% for early and 0 to 2: 1.8%, 3 to 5: 4.4%, 6 to 7: 18.4%, >7: 32.4% for permanently disabling outcomes. The discrimination of the model was 0.80 with 2.8% optimism. Validation in the second patient cohort revealed good performance at risk stratification.
Relative weights assigned to brain eloquence, diffuse nidus morphology and deep venous drainage of a bAVM provide a simple and discriminative prediction model for neurological outcome after bAVM surgery.
建立并验证一种用于预测脑动静脉畸形（bAVM）手术后神经功能障碍的判别模型。
在233例连续纳入的接受bAVM手术的患者中，前175例用于推导预测模型，后58例用于验证该模型。人口统计学和血管造影因素与术后72小时内、术后7天以及术后≥1年时的改良Rankin量表评分相关，以寻找术后神经功能缺损（改良Rankin量表评分≥3）的预测因素。这些因素包括病灶大小、功能区、静脉引流、弥散程度、白质结构、动脉穿支供血以及合并的动脉瘤。
功能区、弥散性病灶和深部静脉引流是早期致残性神经功能缺损的显著预测因素（优势比分别为4.33、3.49和2.38）。这些近似的优势比构成了一个加权的9分预测模型（功能区+弥散程度+深部静脉引流的最高得分=4+3+2）。该评分能够区分早期（第一周）和永久性（≥1年）致残性神经功能缺损的概率如下：0至2分：1.8%，3至5分：17.4%，6至7分：31.6%，＞7分：早期为52.9%，永久性致残结局为32.4%。该模型的判别度为0.80，乐观估计为2.8%。在第二个患者队列中的验证显示该模型在风险分层方面表现良好。
bAVM的功能区、弥散性病灶形态和深部静脉引流的相对权重为bAVM手术后的神经功能结局提供了一个简单且具有判别性的预测模型。
