From the Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia (M.K., N.A., M.K.M.); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (M.K.); and Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland (D.B.).
Stroke. 2014 Dec;45(12):3549-55. doi: 10.1161/STROKEAHA.114.007206. Epub 2014 Oct 16.
Management of brain arteriovenous malformation (bAVM) is controversial. We have analyzed the largest surgical bAVM cohort for outcome.
Both operated and nonoperated cases were included for analysis. A total of 779 patients with bAVMs were consecutively enrolled between 1989 and 2014. Initial management recommendations were recorded before commencement of treatment. Surgical outcome was prospectively recorded and outcomes assigned at the last follow-up visit using modified Rankin Scale. First, a sensitivity analyses was performed to select a subset of the entire cohort for which the results of surgery could be generalized. Second, from this subset, variables were analyzed for risk of deficit or near miss (intraoperative hemorrhage requiring blood transfusion of ≥2.5 L, hemorrhage in resection bed requiring reoperation, and hemorrhage associated with either digital subtraction angiography or embolization).
A total of 7.7% of patients with Spetzler-Ponce classes A and B bAVM had an adverse outcome from surgery leading to a modified Rankin Scale >1. Sensitivity analyses that demonstrated outcome results were not subject to selection bias for Spetzler-Ponce classes A and B bAVMs. Risk factors for adverse outcomes from surgery for these bAVMs include size, presence of deep venous drainage, and eloquent location. Preoperative embolization did not affect the risk of perioperative hemorrhage.
Most of the ruptured and unruptured low and middle-grade bAVMs (Spetzler-Ponce A and B) can be surgically treated with a low risk of permanent morbidity and a high likelihood of preventing future hemorrhage. Our results do not apply to Spetzler-Ponce C bAVMs.
脑动静脉畸形（bAVM）的治疗存在争议。我们分析了最大的手术治疗 bAVM 队列的结果。
本研究纳入了 1989 年至 2014 年间连续就诊的 779 例 bAVM 患者，包括手术和非手术患者。在开始治疗前记录初始治疗建议。前瞻性记录手术结果，并在最后一次随访时使用改良 Rankin 量表进行评估。首先，进行敏感性分析，选择可推广手术结果的整个队列子集。其次，从该子集中分析导致缺陷或接近失误的风险因素（术中需要输血≥2.5L 的出血、切除部位需要再次手术的出血、与数字减影血管造影或栓塞相关的出血）。
Spetzler-Ponce 分级 A 和 B 的 bAVM 患者中，有 7.7%的手术结果不良，导致改良 Rankin 量表评分>1。敏感性分析表明，Spetzler-Ponce 分级 A 和 B 的 bAVM 不存在选择偏倚。这些 bAVM 手术不良结局的风险因素包括大小、深静脉引流和功能区位置。术前栓塞不会增加围手术期出血的风险。
大多数低级别和中级别 Spetzler-Ponce A 和 B 的破裂和未破裂 bAVM 可通过手术治疗，其永久性致残风险低，预防未来出血的可能性高。我们的结果不适用于 Spetzler-Ponce C 的 bAVM。
