Sorenson Thomas J, Brinjikji Waleed, Bortolotti Carlo, Kaufmann Gabriel, Lanzino Giuseppe
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2018 Aug;116:e856-e866. doi: 10.1016/j.wneu.2018.05.117. Epub 2018 May 26.
Risk factors for the recurrence of surgically excised brain arteriovenous malformations (AVMs) are poorly understood. In addition, ideal follow-up imaging paradigms to catch AVM recurrences are not well defined. We present a systematic review on risk factors for the recurrence of surgically resected AVMs and identify potential theories of recurrence.
A literature search was performed by a reference librarian, and after screening, 14 case reports and 16 case series were left for inclusion in the review. All possible data were abstracted by 2 authors, and the results were tabulated and descriptive statistics (mean, range; and proportions) were reported. No formal statistical analysis was performed as part of this study.
Systematic review of the literature revealed 73 patients with a surgically resected AVM that recurred. The average age of first AVM presentation was 13.8 years, and most patients presented with hemorrhage (90%). After angiographically confirmed complete surgical resection, average time to AVM recurrence was 4.2 years. Rate of recurrence was 2.7% in adult series or case reports (n = 8). When we analyzed only pediatric case reports or series (n = 12), the average rate of recurrence was 9.5% but was as high as almost 14% in a series with compulsory short-term follow-up serial imaging. Four (5.5%) patients experienced re-recurrence of AVM after complete surgical excision of first AVM recurrence.
AVM recurrence after complete surgical resection is a recognized risk that occurs primarily in children. Follow-up imaging within 1 year of surgery is strongly indicated for pediatric patients with surgically resected AVMs, even with postoperative angiographically confirmed complete excision.
对于手术切除的脑动静脉畸形（AVM）复发的危险因素，人们了解甚少。此外，用于发现AVM复发的理想随访成像模式也尚未明确界定。我们对手术切除AVM复发的危险因素进行了系统综述，并确定了潜在的复发理论。
由一名文献管理员进行文献检索，经筛选后，有14篇病例报告和16篇病例系列纳入该综述。两名作者提取了所有可能的数据，并制成表格，报告了描述性统计数据（均值、范围和比例）。本研究未进行正式的统计分析。
对文献的系统综述显示，有73例接受手术切除的AVM复发患者。首次出现AVM的平均年龄为13.8岁，大多数患者表现为出血（90%）。经血管造影证实手术完全切除后，AVM复发的平均时间为4.2年。成人系列病例报告中的复发率为2.7%（n = 8）。当我们仅分析儿科病例报告或系列（n = 12）时，平均复发率为9.5%，但在一个有强制性短期随访系列成像的系列中高达近14%。4例（5.5%）患者在首次AVM复发完全手术切除后出现AVM再次复发。
完全手术切除后AVM复发是一种公认的风险，主要发生在儿童中。对于接受手术切除AVM的儿科患者，即使术后血管造影证实完全切除，强烈建议在术后1年内进行随访成像。
