Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea.
J Neurol Neurosurg Psychiatry. 2014 Dec;85(12):1366-70. doi: 10.1136/jnnp-2013-306844. Epub 2014 Mar 28.
The purpose of this study was to assess the risk factors of prospective symptomatic haemorrhage in a large series of adult patients with cerebral cavernous malformation (CM).
Three hundred twenty-six patients >18 years of age with 410 CMs were evaluated retrospectively. Symptomatic haemorrhage was defined as new clinical symptoms with radiographic features of haemorrhage. Clinical data and the characteristics of CM were analysed. MR appearance was divided into three groups according to Zabramski's classification.
The overall haemorrhage rate of CM was 4.46% per lesion-year. The overall annual haemorrhage rate according to MR appearance was as follows: type I, 9.47%; type II, 4.74%; and type III, 1.43%. A multivariate analysis revealed that prior symptomatic haemorrhage (p<0.001) and MR appearance (p<0.001) were statistically significant. After multiple comparisons, type I (p<0.001) and type II (p=0.016) showed higher haemorrhage risk than type III. However, no significant difference in haemorrhage rate was observed between type I and type II (p=0.105). Other variables including female gender, age, location, multiplicity, hypertension, size and associated venous angioma were not significant. The haemorrhage rates based on risk factors were estimated at 3 years as follows: 33.77% in patients with prior haemorrhage versus 7.54% in patients without prior haemorrhage (p<0.001); type I, 27.62% vs type II, 15.44% vs type III, 5.38% (p<0.001).
Prior symptomatic haemorrhage and MR appearance could be related to prospective symptomatic CM haemorrhage in adults. A prospective multicentre observational study is necessary to confirm our results.
本研究旨在评估大型成年脑动静脉畸形（CM）患者系列中潜在症状性出血的危险因素。
回顾性评估了 326 名年龄大于 18 岁且有 410 个 CM 的患者。有症状性出血定义为具有出血影像学特征的新临床症状。分析临床资料和 CM 特征。根据 Zabramski 分类，将 MR 外观分为三组。
CM 的总体出血率为每病变年 4.46%。根据 MR 外观，总体年出血率如下：I 型，9.47%；II 型，4.74%；III 型，1.43%。多变量分析显示，先前的症状性出血（p<0.001）和 MR 外观（p<0.001）具有统计学意义。经多次比较，I 型（p<0.001）和 II 型（p=0.016）出血风险高于 III 型。然而，I 型和 II 型之间的出血率无显著差异（p=0.105）。其他变量，包括女性、年龄、位置、多发性、高血压、大小和伴发静脉血管畸形均无统计学意义。基于危险因素的出血率估计如下：有既往出血的患者为 3 年 33.77%，无既往出血的患者为 7.54%（p<0.001）；I 型为 27.62%，II 型为 15.44%，III 型为 5.38%（p<0.001）。
既往症状性出血和 MR 表现与成人潜在症状性 CM 出血相关。有必要开展前瞻性多中心观察研究来证实我们的结果。
