Department of Neurosurgery, Division of Neurosciences and Locomotive System, Lille University Hospital, Lille, France.
Neurosurgery. 2012 Jan;70(1):155-61; discussion 161. doi: 10.1227/NEU.0b013e31822670ac.
Brainstem arteriovenous malformations are challenging lesions, and benefits of treatment are uncertain.
To study the clinical course of Brainstem arteriovenous malformations and the influence of treatments on outcome.
We reviewed a prospective series of 31 brainstem arteriovenous malformations. Demographic, morphological, and clinical characteristics were recorded. Factors determining initial and final outcomes (modified Rankin Scale), results of treatments (cure rates, complications), and disease course were analyzed.
Brainstem arteriovenous malformations were symptomatic and bled in 93% and 61% of cases, respectively. Examination was abnormal and initial modified Rankin Scale score was < 3 in 71% and 86% of patients, respectively. The average follow-up time was 6.2 years, and 26% of patients rebled (5.9 %/y). Treatment modalities included conservative, radiosurgical, endovascular, surgical, and multimodality treatment in 13%, 58%, 35%, 16%, and 26% of cases, respectively. The obliteration rate was 60% overall and 39% after radiosurgery, 40% after embolization, and 75% after microsurgery, with respective complication-free cure rates of 71%, 50%, and 0%. Overall procedural mortality and morbidity were 2.3% and 18.6%, respectively. Final modified Rankin Scale score was < 3 in 77% of cases. Neurological deterioration (35%) was related to treatment complications in 74% of cases with a negative impact of surgery (P = .04), palliative embolization (odds ratio = 16), and multimodality treatments (odds ratio = 24). Radiosurgery was inversely associated with worsening (odds ratio = 0.06).
Brainstem arteriovenous malformations require individualized treatment decisions. Single-modality treatments with a reasonable chance of complete cure and low complication rate (such as radiosurgery) should be favored.
脑干动静脉畸形是具有挑战性的病变，治疗的益处尚不确定。
研究脑干动静脉畸形的临床过程以及治疗对结局的影响。
我们回顾了一系列前瞻性的 31 例脑干动静脉畸形患者。记录了人口统计学、形态学和临床特征。分析了决定初始和最终结局（改良 Rankin 量表）、治疗结果（治愈率、并发症）和疾病过程的因素。
脑干动静脉畸形分别有 93%和 61%的病例有症状和出血。检查异常，初始改良 Rankin 量表评分为<3 的分别占 71%和 86%的患者。平均随访时间为 6.2 年，26%的患者再次出血（5.9%/y）。治疗方式包括保守治疗、放射外科治疗、血管内治疗、手术治疗和多模态治疗，分别占 13%、58%、35%、16%和 26%的病例。总的闭塞率为 60%，放射外科治疗后为 39%，栓塞治疗后为 40%，显微手术后为 75%，相应的无并发症治愈率分别为 71%、50%和 0%。总的手术死亡率和发病率分别为 2.3%和 18.6%。最终改良 Rankin 量表评分<3 的占 77%。74%的病例出现神经恶化（35%）与治疗并发症有关，手术（P=0.04）、姑息性栓塞（比值比=16）和多模态治疗（比值比=24）有负面影响。放射外科治疗与恶化呈负相关（比值比=0.06）。
脑干动静脉畸形需要个体化的治疗决策。应优先选择有合理完全治愈机会和低并发症率的单一治疗方式（如放射外科治疗）。
