Kang Kaijiang, Ju Yi, Wang Dandan, Li Huan, Sun Liqian, Ma Kaiqiang, Zhao Xingquan, Lu Jingjing
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2018 Dec;120:e472-e479. doi: 10.1016/j.wneu.2018.08.106. Epub 2018 Aug 25.
We elucidated the clinical and radiological characteristics and analyzed the risk factors for hemorrhage and poor outcomes of cerebral venous malformations (CVMs) in a northern Chinese population.
We included 60 consecutive patients with CVM patients in Beijing Tiantan Hospital from January 2011 to February 2018. The clinical manifestations, radiological characteristics, management, and outcomes were elucidated and analyzed. The patients were followed up for 5-64 months (median, 26). Poor outcomes included repeat bleeding, secondary infarction, severe disability (modified Rankin scale score ≥3), and death.
Infratentorial CVMs were more prone to intracranial hemorrhage (75% vs. 28.6%; P < 0.001), dizziness (37.5% vs. 10.7%; P = 0.017), and focal neurological deficits (65.6% vs. 25%; P = 0.002) than were supratentorial CVMs. Supratentorial CVMs were more prone to seizure (32.1% vs. 0%; P = 0.001) than were infratentorial CVMs. Multivariate logistic regression revealed that the major risk factors for intracranial hemorrhage in CVMs were infratentorial lesions (P = 0.003) and complicated cavernous angiomas (P = 0.016). Compared with conservative treatment, resection of hematoma or cavernous angiomas with CVM preservation did not increase the risk of poor outcomes (P = 0.646). However, CVM resection significantly increased that risk (odds ratio, 44.0; P = 0.003).
Our results have shown that conservative treatment of CVMs results in a relatively good prognosis. For those complicated by hemorrhage or cavernous angiomas requiring surgical interventions, the integrity of the CVM should be preserved, irrespective of the treatment. In exceptional cases, before CVM resection, the CVM drainage should be comprehensively evaluated.
我们阐明了中国北方人群中脑静脉畸形（CVM）的临床和影像学特征，并分析了出血及预后不良的危险因素。
我们纳入了2011年1月至2018年2月在北京天坛医院连续就诊的60例CVM患者。对其临床表现、影像学特征、治疗及预后进行阐明和分析。患者随访5 - 64个月（中位数为26个月）。预后不良包括再次出血、继发性梗死、严重残疾（改良Rankin量表评分≥3）及死亡。
幕下CVM比幕上CVM更容易发生颅内出血（75% 对28.6%；P < 0.001）、头晕（37.5% 对10.7%；P = 0.017）及局灶性神经功能缺损（65.6% 对25%；P = 0.002）。幕上CVM比幕下CVM更容易发生癫痫（32.1% 对0%；P = 0.001）。多因素logistic回归显示，CVM颅内出血的主要危险因素是幕下病变（P = 0.003）和合并海绵状血管瘤（P = 0.016）。与保守治疗相比，保留CVM切除血肿或海绵状血管瘤不会增加预后不良的风险（P = 0.646）。然而，切除CVM会显著增加该风险（比值比为44.0；P = 0.003）。
我们的结果表明，CVM的保守治疗预后相对较好。对于那些合并出血或需要手术干预的海绵状血管瘤的患者，无论采用何种治疗方法，都应保留CVM的完整性。在特殊情况下，在切除CVM之前，应全面评估CVM的引流情况。
