Fukuda Keiko, Majumdar Monica, Masoud Hesham, Nguyen Thanh, Honarmand Amir, Shaibani Ali, Ansari Sameer, Tan Lee A, Chen Michael
Rush Medical College, Chicago, Illinois, USA.
Department of Neurology, SUNY Upstate Medical University, Syracuse, New York, USA.
J Neurointerv Surg. 2017 Jul;9(7):664-668. doi: 10.1136/neurintsurg-2016-012485. Epub 2016 Jun 22.
The optimal management strategy for unruptured cerebral arteriovenous malformations (AVMs) is controversial since the ARUBA trial (A Randomized trial of Unruptured Brain AVMs). An accurate understanding of the morbidity associated with AVM hemorrhages may help clinicians to formulate the best treatment strategy for unruptured AVMs.
To determine the morbidity associated with initial cerebral AVM rupture in patients presenting to tertiary medical centers.
Retrospective chart reviews from three tertiary academic medical centers were performed for the period between 2008 and 2014. All patients admitted with intracranial hemorrhage due to untreated AVMs were included in this study. Patient-specific variables, including demographics, imaging characteristics, neurologic examination results, and clinical outcome, were analyzed and recorded.
101 Patients met the inclusion criteria. Admission National Institutes of Health Stroke Scale (NIHSS) scores were 0, 1-9, and ≥10 in 26%, 29%, and 45% of patients, respectively. Hematoma locations were subarachnoid, intraventricular, intraparenchymal, and combined in 5%, 11%, 32%, and 52% of patients, respectively. Deep venous drainage was present in 43% of AVMs; AVM-associated aneurysms were present in 44% of patients. Emergent hematoma evacuations were performed in 37% of patients and 8% of patients died while in hospital. At discharge, of those who survived, NIHSS scores of ≥1 and ≥10 were found in 69% and 23%, respectively. At the 90-day follow-up, 34% had a modified Rankin Scale (mRS) score >2. Patients with admission NIHSS score ≥10 had significantly higher rates of midline shift, surgical hematoma evacuation, and follow-up mRS ≥3 (p<0.05).
The morbidity associated with cerebral AVM rupture appeared to be higher in our study than previously reported. Morbidity from AVM rupture should be considered as an important factor, together with variables such as risk of AVM rupture and procedural risk, in determining the optimal treatment strategy for unruptured cerebral AVMs.
自ARUBA试验（未破裂脑动静脉畸形随机试验）以来，未破裂脑动静脉畸形（AVM）的最佳管理策略一直存在争议。准确了解与AVM出血相关的发病率可能有助于临床医生为未破裂AVM制定最佳治疗策略。
确定在三级医疗中心就诊的患者中，初次脑AVM破裂相关的发病率。
对三个三级学术医疗中心2008年至2014年期间的病历进行回顾性审查。本研究纳入了所有因未经治疗的AVM导致颅内出血而入院的患者。分析并记录患者的特定变量，包括人口统计学、影像学特征、神经系统检查结果和临床结局。
101例患者符合纳入标准。入院时美国国立卫生研究院卒中量表（NIHSS）评分分别为0、1 - 9和≥10的患者比例分别为26%、29%和45%。血肿部位分别为蛛网膜下腔、脑室内、脑实质内和混合型的患者比例分别为5%、11%、32%和52%。43%的AVM存在深部静脉引流；44%的患者存在与AVM相关的动脉瘤。37%的患者进行了紧急血肿清除术，8%的患者在住院期间死亡。出院时，存活患者中NIHSS评分≥1和≥10的分别占69%和23%。在90天随访时，34%的患者改良Rankin量表（mRS）评分>2。入院NIHSS评分≥10的患者中线移位、手术血肿清除和随访mRS≥3的发生率显著更高（p<0.05）。
在我们的研究中，脑AVM破裂相关的发病率似乎高于先前报道。在确定未破裂脑AVM的最佳治疗策略时，AVM破裂的发病率应与AVM破裂风险和手术风险等变量一起被视为重要因素。
