Arauz Antonio, Patiño-Rodriguez Hernán M, Chavarria-Medina Mónica, Becerril Mayra, Longo Gabriel Mauricio, Nathal Edgar
Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
Cerebrovasc Dis. 2017;43(5-6):283-289. doi: 10.1159/000463392. Epub 2017 Mar 21.
We sought to evaluate the long-term functional outcomes and identify the potential risk factors for rebleeding in patients with brain stem cavernous malformations (BCMs) who presented with hemorrhages and were surgically or conservatively treated and prospectively monitored.
From January 1990 to July 2015, we included patients with first hemorrhagic episodes secondary to single BCMs. Modified Rankin score (mRS) was used for neurological status assessment. Univariate and multivariate regression statistics were used to identify the risk factors for rebleeding.
A total of 99 patients with BCMs hemorrhages were included (59 [59.6%] women, mean age 37± 13 years). As initial treatments, 37 patients (37.4%) underwent surgery and 62 (62.6%) received conservative treatment. The median follow-up was 3.33 years (interquartile range 1.16-7 years; 408.3 patient/years). The rebleeding rate by patient/year was 10% in conservatively treated patients. Deterioration was significantly more frequent in patients with rebleeding (p = 0.0001). At the end of the follow-up, the mRS were favorable in 49 patients (65.3%) without rebleeding, whereas only 8 (33.3%) with rebleeding evolved to favorable outcomes (p = 0.006). Lesion size >18 mm (hazards ratio, HR 3.34, 95% CI 1.54-7.26; p = 0.0001) and ventral location or crossing the brain stem's midpoint (HR 2.5, 95% CI 1.14-5.46; p = 0.022) were associated with a major risk of rebleeding in the univariate analysis, but only a lesion >18 mm remained statistically significant (HR 2.7, 95% CI 1.2-6.21; p = 0.016) in the multivariate analysis.
A lesion size >18 mm was the principal factor associated with hemorrhage recurrence. The overall functional outcome was good. However, significant morbidity was attributable to rebleeding.
我们试图评估脑干海绵状血管畸形（BCM）伴出血患者经手术或保守治疗及前瞻性监测后的长期功能结局，并确定再出血的潜在危险因素。
1990年1月至2015年7月，我们纳入了因单发BCM导致首次出血发作的患者。采用改良Rankin量表（mRS）评估神经功能状态。使用单因素和多因素回归统计来确定再出血的危险因素。
共纳入99例BCM出血患者（59例[59.6%]为女性，平均年龄37±13岁）。作为初始治疗，37例患者（37.4%）接受了手术，62例（62.6%）接受了保守治疗。中位随访时间为3.33年（四分位间距1.16 - 7年；408.3患者/年）。保守治疗患者的年再出血率为10%。再出血患者的病情恶化明显更频繁（p = 0.0001）。随访结束时，49例（65.3%）未再出血患者的mRS评分为良好，而只有8例（33.3%）再出血患者的结局为良好（p = 0.006）。单因素分析中，病灶大小>18 mm（风险比，HR 3.34，95%可信区间1.54 - 7.26；p = 0.0001）以及腹侧位置或跨越脑干中点（HR 2.5，95%可信区间1.14 - 5.46；p = 0.022）与再出血的主要风险相关，但多因素分析中只有病灶>18 mm仍具有统计学意义（HR 2.7，95%可信区间1.2 - 6.21；p = 0.016）。
病灶大小>18 mm是与出血复发相关的主要因素。总体功能结局良好。然而，再出血导致了显著的发病率。
