Lai Ling-Feng, Chen Min, Chen Jia-Xiang, Zheng Kuang, He Xu-Ying, Li Xi-Feng, Zhang Xin, Yin Jian, Wang Qiu-Jing, Zou Tuan-Ming, Duan Chuan-Zhi
The National Key Clinical Specialty. The Engineering Technology Research Center of Education. Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Department of Otolaryngology, The First People's Hospital of Foshan, China.
Pain Physician. 2017 Jan-Feb;20(1):E127-E136.
Symptomatic headaches attributed to unruptured brain arteriovenous malformations (ubAVMs) are very common and affect patients' quality life, but multidisciplinary care of ubAVMs to improve symptomatic headache remains unclear.
The objective is to identify the features of symptomatic headaches, and to obtain headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on the natural history of ubAVMs.
The features of symptomatic headaches and headache outcomes were analyzed in a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information on the natural history of ubAVMs.
This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where 336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were eligible.
The demographics, clinical features, imaging features, and headache details of eligible patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional outcomes (modified Rankin Scale score = 2, mRS = 2) were assessed following multidisciplinary care of ubAVMs.
Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital lobe (P < 0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in frontotemporal lobe (P < 0.001). For patients with tension-type-like or all types of headache, headache improvement differed between the multidisciplinary group and medical group (87.8% vs. 31.8%, P < 0.001; 85.7% vs. 40.7%, P < 0.001). The risk of death or stroke did not differ between multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional outcome (mRS = 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022).
This study provides the initial experience to support multidisciplinary care for ubAVMs to improve symptomatic headaches and patients' quality life, but based on the retrospective study with inherent limitations, larger samples and multi-center trials are needed on this interesting issue.
Occipital ubAVM is more likely to present with migraine-like headache, while frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of ubAVM patients with headache remains unclear.Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement, natural history.
归因于未破裂脑动静脉畸形（ubAVM）的症状性头痛非常常见，影响患者生活质量，但关于ubAVM的多学科治疗以改善症状性头痛仍不明确。
确定症状性头痛的特征，获得ubAVM多学科治疗后的头痛结局，并提供ubAVM自然史的背景信息。
在ubAVM多学科治疗后的一大组病例中分析症状性头痛的特征和头痛结局。我们还提供了ubAVM自然史的信息。
本研究在珠江医院神经外科进行，1998年至2014年期间由多学科团队对336例患者进行了评估。只有124例患者符合条件。
回顾符合条件患者的人口统计学、临床特征、影像学特征和头痛细节。采用11分疼痛量表评分评估治疗前、治疗期间和治疗后的症状性头痛。在ubAVM多学科治疗后评估头痛结局、死亡或卒中以及不良功能结局（改良Rankin量表评分=2，mRS=2）。
41例患者中有23例（56.1%）出现位于枕叶的偏头痛样头痛（P<0.001），而63例患者中有40例（63.5%）出现位于额颞叶的紧张型样头痛（P<0.001）。对于紧张型样或所有类型头痛的患者，多学科组和药物组的头痛改善情况不同（87.8%对31.8%，P<0.001；85.7%对40.7%，P<0.001）。多学科组和药物组的死亡或卒中风险无差异（P=0.393），而长期随访后不良功能结局（mRS=2）的风险有显著差异（23.0%对10.0%，P=0.022）。
本研究提供了支持ubAVM多学科治疗以改善症状性头痛和患者生活质量的初步经验，但基于具有固有局限性的回顾性研究，在这个有趣的问题上需要更大样本和多中心试验。
枕叶ubAVM更可能出现偏头痛样头痛，而额颞叶ubAVM倾向于出现紧张型样头痛。已显示ubAVM多学科治疗改善头痛的有效性，但伴有头痛的ubAVM患者的自然史仍不明确。关键词：未破裂脑动静脉畸形，头痛，头痛改善，自然史。
