Yang Wuyang, Porras Jose L, Garzon-Muvdi Tomas, Xu Risheng, Caplan Justin M, Hung Alice L, Braileanu Maria, Rong Xiaoming, Colby Geoffrey P, Coon Alexander L, Tamargo Rafael J, Huang Judy
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
World Neurosurg. 2016 Oct;94:64-72. doi: 10.1016/j.wneu.2016.06.082. Epub 2016 Jun 28.
Management decisions for brainstem arteriovenous malformations (AVMs) are complicated by balancing the risks of treatment and natural progression to hemorrhage. The present study seeks to compare radiosurgery and conservative management outcomes in brainstem AVMs.
We performed a retrospective review of patients with brainstem AVM seen at our institution from 1990 to 2013. Patients missing baseline information or those lost to follow-up were excluded. Clinical and angiographic characteristics and subsequent hemorrhagic risk were evaluated according to brainstem AVM location and treatment modality.
We identified 30 patients with brainstem AVM with complete data. Mean age was 41.6 ± 20.3 years, and 53.3% (n = 16) were male. Sixteen (53.3%) presented with hemorrhage. Twelve patients (40.0%) were conservatively managed, and 18 were treated. Sixteen (88.9%) of the treated patients underwent radiosurgery, 1 (5.6%) underwent surgery, and 1 (5.6%) underwent embolization only. Average follow-up period was 4.7 ± 5.7 years, and 5 patients (16.7%) experienced recurrent hemorrhage, 3 of whom were in the radiosurgery group and 2 in the conservative group, giving an annual recurrent hemorrhage risk of 3.7% and 4.8%, respectively. Lesion obliteration was achieved in 8 patients (26.7%). Baseline clinical and angiographic factors were similar between the radiosurgery and conservative group. Obliteration was achieved in 43.8% of those treated with radiosurgery (P = 0.008). Despite similar baseline modified Rankin Scale scores, more patients had improvement of modified Rankin Scale score at last follow-up in the radiosurgery group (P = 0.004). Recurrent hemorrhage during follow-up was similar between the 2 groups (P = 0.887).
Our results suggest that when patients with brainstem AVM are selected cautiously, radiosurgery may achieve obliteration and symptom relief without increasing subsequent hemorrhage risk.
脑干动静脉畸形（AVM）的治疗决策因平衡治疗风险和自然出血进展风险而变得复杂。本研究旨在比较脑干AVM的放射外科治疗和保守治疗的结果。
我们对1990年至2013年在我院就诊的脑干AVM患者进行了回顾性研究。排除缺少基线信息或失访的患者。根据脑干AVM的位置和治疗方式评估临床和血管造影特征以及随后的出血风险。
我们确定了30例具有完整数据的脑干AVM患者。平均年龄为41.6±20.3岁，53.3%（n = 16）为男性。16例（53.3%）出现出血。12例患者（40.0%）接受保守治疗，18例接受治疗。16例（88.9%）接受治疗的患者接受了放射外科治疗，1例（5.6%）接受了手术，1例（5.6%）仅接受了栓塞治疗。平均随访期为4.7±5.7年，5例患者（16.7%）发生复发性出血，其中3例在放射外科治疗组，2例在保守治疗组，年复发性出血风险分别为3.7%和4.8%。8例患者（26.7%）实现了病变闭塞。放射外科治疗组和保守治疗组的基线临床和血管造影因素相似。接受放射外科治疗的患者中有43.8%实现了闭塞（P = 0.008）。尽管基线改良Rankin量表评分相似，但放射外科治疗组在最后一次随访时改良Rankin量表评分改善的患者更多（P = 0.004）。两组随访期间的复发性出血情况相似（P = 0.887）。
我们的结果表明，当谨慎选择脑干AVM患者时，放射外科治疗可能在不增加后续出血风险的情况下实现闭塞和症状缓解。
