Morgan Michael K, Heller Gillian Z
Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia -
Department of Statistics, Macquarie University, Sydney, NSW, Australia.
J Neurosurg Sci. 2018 Aug;62(4):429-436. doi: 10.23736/S0390-5616.18.04371-0. Epub 2018 Feb 23.
There is uncertainty of the benefit of preoperative embolization for Spetzler-Ponce Class (SPC) B and C arteriovenous malformations of the brain (bAVM). We examined whether or not preoperative embolization reduces the risk of permanent neurological deficits in SPC B and C bAVM surgery.
A prospective bAVM database (between1989 and 2015) was analyzed by regression for factors associated with a new permanent neurological deficit arising as a consequence of surgery or preoperative embolization with a modified Rankin Scale (mRS) score >1 at 12 months after surgery (adverse outcome).
From a cohort of 785 patients with bAVM, 277 patients with SPC B or C bAVM were planned for treatment by surgery with (N.=67) or without (N.=210) preoperative embolization. There were significant differences (embolization versus no embolization) in: permanent neurological deficits leading to a mRS>1 (45% versus 20%, P<0.01); permanent neurological deficits leading to a mRS>2 (22% versus 8.1%, P=0.04); perioperative transfusion of 2.5 liters of blood or more (31% versus 16%, P<0.01); and, delayed postoperative hemorrhage (19% versus 8.1%, P=0.01). Regression analysis identified the following factors to be associated with increased likelihood of an adverse outcome: infratentorial location (odds ratio 0.441, P=0.045); SPC C bAVM (OR=0.501, P=0.034); earlier rank order of surgery (OR=0.994, P<0.01); and, preoperative embolization (OR=0.313, P<0.01).
The use of preoperative embolization does not reduce adverse outcomes in SPC B and C bAVM. The role of embolization in the preoperative management of complex bAVM by surgery deserves further study.
对于斯佩茨勒-庞塞分级（SPC）为B级和C级的脑动静脉畸形（bAVM），术前栓塞的益处尚不确定。我们研究了术前栓塞是否能降低SPC B级和C级bAVM手术中永久性神经功能缺损的风险。
对一个前瞻性bAVM数据库（1989年至2015年）进行回归分析，以确定与术后12个月因手术或术前栓塞导致改良Rankin量表（mRS）评分>1的新的永久性神经功能缺损（不良结局）相关的因素。
在785例bAVM患者队列中，277例SPC B级或C级bAVM患者计划接受手术治疗，其中67例接受了术前栓塞，210例未接受术前栓塞。在以下方面存在显著差异（栓塞组与未栓塞组）：导致mRS>1的永久性神经功能缺损（45%对20%，P<0.01）；导致mRS>2的永久性神经功能缺损（22%对8.1%，P=0.04）；围手术期输血2.5升或更多（31%对16%，P<0.01）；以及术后延迟出血（19%对8.1%，P=0.01）。回归分析确定以下因素与不良结局可能性增加相关：幕下位置（比值比0.441，P=0.045）；SPC C级bAVM（OR=0.501，P=0.034）；手术较早的排序（OR=0.994，P<0.01）；以及术前栓塞（OR=0.313，P<0.01）。
术前栓塞的应用并未降低SPC B级和C级bAVM的不良结局。栓塞在复杂bAVM手术术前管理中的作用值得进一步研究。
