一种用于脑动静脉畸形血管内治疗的拟议分级系统：布法罗评分
A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score.
作者信息
Dumont Travis M, Kan Peter, Snyder Kenneth V, Hopkins L Nelson, Siddiqui Adnan H, Levy Elad I
机构信息
Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Division of Neurosurgery, Department of Surgery, The University of Arizona, Tucson, Arizona, USA.
Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
出版信息
Surg Neurol Int. 2015 Jan 7;6:3. doi: 10.4103/2152-7806.148847. eCollection 2015.
BACKGROUND
The Spetzler-Martin arteriovenous malformation (AVM) grading system has proven to be useful in guiding treatment of cerebral AVMs with craniotomy. It is based on anatomical characteristics each of which makes surgical resection of an AVM more difficult, namely, deep venous drainage, eloquence of surrounding tissue, and large nidus size. A higher score correlates with more complications after treatment. Although this grading system has proven reliable over time, it does not reflect the major determinants of risk associated with endovascular treatment. The authors developed a grading system unique to endovascular treatment of cerebral AVMs.
METHODS
The proposed grading system accounts for the principal AVM anatomical and physiological features that make endovascular embolization more difficult and, thus, the likelihood of complications greater. These include number of arterial pedicles, diameter of arterial pedicles, and eloquent location of AVM nidus. The proposed grading system was retrospectively applied to 50 patients undergoing endovascular AVM embolization, and its ability to predict complications was compared to the Spetzler-Martin grading system.
RESULTS
Perioperative complications among the 50 patients included 4 major and 9 minor complications. The proposed grading system was predictive of complication risk, with an increasing rate of perioperative complications associated with an increasing AVM grade. An improved correlation of perioperative complication incidence was noted with the proposed system (P = 0.002), when compared with the Spetzler-Martin grading system (P = 0.33).
CONCLUSION
This grading system for the endovascular treatment of AVMs is simple, easily reproduced, and clinically valuable.
背景
斯佩茨勒-马丁动静脉畸形（AVM）分级系统已被证明在指导开颅手术治疗脑动静脉畸形方面很有用。它基于解剖学特征，每个特征都会使AVM的手术切除更加困难，即深部静脉引流、周围组织的功能区以及大的畸形团大小。更高的分数与治疗后更多的并发症相关。尽管随着时间的推移，该分级系统已被证明是可靠的，但它并未反映与血管内治疗相关的主要风险决定因素。作者开发了一种专门用于脑动静脉畸形血管内治疗的分级系统。
方法
所提出的分级系统考虑了使血管内栓塞更加困难并因此使并发症可能性更大的主要AVM解剖和生理特征。这些特征包括动脉蒂的数量、动脉蒂的直径以及AVM畸形团的功能区位置。所提出的分级系统被回顾性应用于50例接受血管内AVM栓塞的患者，并将其预测并发症的能力与斯佩茨勒-马丁分级系统进行比较。
结果
50例患者的围手术期并发症包括4例严重并发症和9例轻微并发症。所提出的分级系统可预测并发症风险，围手术期并发症发生率随着AVM分级的增加而增加。与斯佩茨勒-马丁分级系统（P = 0.33）相比，所提出的系统围手术期并发症发生率的相关性得到改善（P = 0.002）。
结论
这种用于AVM血管内治疗的分级系统简单、易于重复且具有临床价值。
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