Ren Qingqing, He Min, Zeng Yunhui, Liu Zhiyong, Liu Hao, Xu Jianguo
Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China.
PLoS One. 2017 Mar 21;12(3):e0174325. doi: 10.1371/journal.pone.0174325. eCollection 2017.
The management of intracranial arteriovenous malformations(AVMs) poses challenges to the cerebrovascular specialists.
To review the long-term outcomes of intracranial AVMs treated with microsurgical resections.
We performed a retrospective review of 445 patients with intracranial AVMs treated in our hospital from January 1st, 2008 to December 31st, 2014. The extracted data included demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, Supplemented Spetzler-Martin (SM-Supp) Grades, treatment modalities, long-term outcomes, and obliteration rates. Outcome was assessed with a post-operative modified Rankin Scale (mRS) score at the last follow-up visit.
Of the 445 patients treated with microsurgery, 298 (67.0%) patients initially presented with hemorrhage. Based on the SM grading system, the patients were graded as follows: 83(18.6%) Grade I, 156(35.1%) Grade II, 132(29.7%) Grade III, 61(13.7%) Grade IV and 13(2.9%) Grade V. Overall, 344(77.3%) patients had a favorable outcome (mRS score of 0-2). The favorable outcome for Grade I and II were 92.8% and 85.9%, respectively, sharply reducing to 52.5% in patients with Grade IV and 15.4% in patients with Grade V AVMs. 388(87.2%) patients achieved complete obliteration of the AVMs. 63(14.2%) patients experienced recurrent hemorrhage, and the frequency of rehemorrhage was highest in Grade V patients (77.0%), dropping to 3.6% and 3.8% in patients with Grade I and II lesions, respectively. Permanent neurological deficits occurred in 66(14.8%) patients and death in 35(7.9%) patients. There was no difference of AUROC values between SM grading system and SM-supp grading system (0.726 and 0.734, respectively, p = .715).
The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Microsurgical resection for AVMs depends on the SM grades, and the morbidity-mortality rate increases with an increasing SM grade.
颅内动静脉畸形（AVM）的治疗给脑血管专家带来了挑战。
回顾显微手术切除颅内AVM的长期疗效。
我们对2008年1月1日至2014年12月31日在我院接受治疗的445例颅内AVM患者进行了回顾性研究。提取的数据包括人口统计学特征、临床表现、Spetzler-Martin（SM）分级、补充Spetzler-Martin（SM-Supp）分级、治疗方式、长期疗效和闭塞率。在最后一次随访时用术后改良Rankin量表（mRS）评分评估疗效。
在445例行显微手术治疗的患者中，298例（67.0%）最初表现为出血。根据SM分级系统，患者分级如下：I级83例（18.6%），II级156例（35.1%），III级132例（29.7%），IV级61例（13.7%），V级13例（2.9%）。总体而言，34例（77.3%）患者预后良好（mRS评分为0-2）。I级和II级患者的良好预后分别为92.8%和85.9%，IV级患者急剧降至52.5%，V级AVM患者降至15.4%。388例（87.2%）患者实现了AVM的完全闭塞。63例（14.2%）患者发生复发性出血，V级患者再出血频率最高（77.0%），I级和II级病变患者分别降至3.6%和3.8%。66例（14.8%）患者出现永久性神经功能缺损，35例（7.9%）患者死亡。SM分级系统和SM-supp分级系统的AUROC值无差异（分别为0.726和0.734，p = 0.715）。
Spetzler-Martin分级系统是一种简单有效的评估手术风险和预后方法。AVM的显微手术切除取决于SM分级，发病率和死亡率随SM分级增加而升高。
