Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2019 Dec;132:e290-e296. doi: 10.1016/j.wneu.2019.08.173. Epub 2019 Aug 31.
Spinal arteriovenous malformations (SAVMs) are a very rare and complex spinal cord pathology that require high clinical acumen to diagnose and treat. Management includes both nonoperative and operative paradigms. A review of the literature yields a paucity of data regarding the surgical outcomes of SAVMs, with the majority of data limited to single-center outcomes and/or small sample sizes. The purpose of this study was to use a multi-institutional international database to study the natural history of SAVMs.
We used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to select patients that underwent laminectomy for surgical excision of a SAVM between 2008 and 2017.
The data from 196 patients were studied (65.8% male, 34.2% female). A majority of cases were in the thoracic region (53.6%), followed by thoracolumbar (31.6%) and cervical (14.8%) regions. The mean age was 57.4 years and 52.5% patients were graded ASA class 3-5 before the operation. The mean operation time was 215 minutes, with a significantly lower operative time for thoracic arteriovenous malformations (195.6 minutes) when compared with cervical (266.6 minutes) and thoracolumbar (223.7 minutes). The mean length of hospital stay was 6.4 days. Patients had a 6.6% readmission rate and a 4.6% reoperation rate within 30 days.
This study presents the largest analysis of patients undergoing surgery for SAVMs and 30-day postoperative outcomes. Operative time differed based on SAVM location. The three most frequent complications (deep vein thrombosis, wound infection, and UTI) occurred at rates of 3.6% or less.
脊髓动静脉畸形（SAVM）是一种非常罕见且复杂的脊髓病理，需要高度的临床敏锐度才能诊断和治疗。治疗方法包括非手术和手术两种。文献回顾显示，关于 SAVM 手术结果的数据很少，大多数数据仅限于单中心结果和/或小样本量。本研究旨在使用多机构国际数据库研究 SAVM 的自然史。
我们使用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库，选择 2008 年至 2017 年间接受椎板切除术以手术切除 SAVM 的患者。
研究了 196 例患者的数据（65.8%为男性，34.2%为女性）。大多数病例位于胸段（53.6%），其次是胸腰椎段（31.6%）和颈段（14.8%）。平均年龄为 57.4 岁，52.5%的患者在手术前被评为 ASA 3-5 级。平均手术时间为 215 分钟，与颈椎（266.6 分钟）和胸腰椎（223.7 分钟）相比，胸段动静脉畸形的手术时间明显较低。平均住院时间为 6.4 天。患者 30 天内的再入院率为 6.6%，再手术率为 4.6%。
本研究是对接受 SAVM 手术的患者和 30 天术后结果进行的最大分析。手术时间因 SAVM 位置而异。最常见的三种并发症（深静脉血栓形成、伤口感染和尿路感染）的发生率为 3.6%或更低。
