Kocer Naci, Kandemirli Sedat Giray, Dashti Reza, Kizilkilic Osman, Hanimoglu Hakan, Sanus Galip Zihni, Tunali Yusuf, Tureci Ercan, Islak Civan, Kaynar Mehmet Yasar
Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, 34098, Istanbul, Turkey.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
Neuroradiology. 2019 Feb;61(2):195-205. doi: 10.1007/s00234-018-2140-z. Epub 2018 Nov 28.
There are no established guidelines for treatment of Spetzler-Martin grade III-V brain arteriovenous malformations (bAVMs). The purpose of this study is to report our institutional experience in total obliteration/eradication of grade III-V bAVMs by single-stage planning of embolization combined with microsurgical resection when necessary.
All patients harboring Spetzler-Martin (S-M) grade III-V bAVMs treated with single-stage planning between January 2006 and January 2018 were retrospectively reviewed. This treatment paradigm is applicable only to surgically accessible bAVMs and does not include deep-seated bAVMs. Indications for treatment, clinical presentation, imaging characteristics, and treatment outcomes were analyzed. Outcomes were assessed based on modified Rankin Scale.
A total of 31 patients were identified. Seventeen patients (54.8%) presented with hemorrhage, 10 (32.3%) with seizures, 3 (9.7%) with headaches, and 1 (3.2%) with progressive neurological deficit. Based on S-M grading system, 25 patients (80.6%) harbored grade III bAVM, 5 patients had grade IV bAVMs (16.1%), and 1 patient (3.2%) had a grade V bAVM. There were no treatment-related complications in 24/31 (77.4%) patients. Of the total of seven patients with complications, four patients had clinical deterioration. The long-term (> 6-month), non-disabling morbidity (mRS ≤ 2) rate was 6.5%. The long-term, disabling morbidity rate was 3.2% with a mortality of 3.2%. Complete angiographic obliteration was achieved in 30/31 (96.8%) patients.
Single-stage treatment strategy can be considered as an alternative to multistage embolization prior to surgery in grade III-V bAVMs. In this study, a high rate of total obliteration with relatively low rates of permanent morbidity and mortality was achieved.
目前尚无针对Spetzler-MartinⅢ - Ⅴ级脑动静脉畸形（bAVM）的既定治疗指南。本研究的目的是报告我们机构在必要时通过单阶段栓塞计划联合显微手术切除实现Ⅲ - Ⅴ级bAVM完全闭塞/根除的经验。
回顾性分析2006年1月至2018年1月间采用单阶段计划治疗的所有Spetzler-Martin（S-M）Ⅲ - Ⅴ级bAVM患者。这种治疗模式仅适用于手术可及的bAVM，不包括深部bAVM。分析治疗指征、临床表现、影像学特征和治疗结果。基于改良Rankin量表评估结果。
共确定31例患者。17例（54.8%）出现出血，10例（32.3%）出现癫痫发作，3例（9.7%）出现头痛，1例（3.2%）出现进行性神经功能缺损。根据S-M分级系统，25例（80.6%）为Ⅲ级bAVM，5例（16.1%）为Ⅳ级bAVM，1例（3.2%）为Ⅴ级bAVM。24/31例（77.4%）患者无治疗相关并发症。在总共7例有并发症的患者中，4例出现临床恶化。长期（>6个月）、非致残性发病率（mRS≤2）为6.5%。长期致残性发病率为3.2%，死亡率为3.2%。30/31例（96.8%）患者实现了血管造影完全闭塞。
单阶段治疗策略可被视为Ⅲ - Ⅴ级bAVM手术前多阶段栓塞的替代方案。在本研究中，实现了高比例的完全闭塞，永久性发病率和死亡率相对较低。
