立体定向放射外科治疗硬脑膜动静脉瘘后结局预测的分级量表建议。
A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas.
机构信息
Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
出版信息
Neurosurgery. 2020 Aug 1;87(2):247-255. doi: 10.1093/neuros/nyz401.
BACKGROUND
There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS).
OBJECTIVE
To design a practical grading system that would predict outcomes after SRS for cranial dAVFs.
METHODS
From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified.
RESULTS
Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan-Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001).
CONCLUSION
The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems.
背景
目前尚无专门针对立体定向放射外科（SRS）后颅硬脑膜动静脉瘘（dAVF）结局的分级量表。
目的
设计一种实用的分级系统，以预测 SRS 后颅 dAVF 的结局。
方法
本研究纳入了来自国际放射外科研究基金会（匹兹堡大学[41 例]、宾夕法尼亚大学[6 例]、舍布鲁克大学[2 例]、马尼托巴大学[1 例]、西弗吉尼亚大学[2 例]、波多黎各大学[1 例]、Beaumont Health System 1[1 例]、Na Homolce 医院[13 例]、弗吉尼亚大学[48 例]和耶鲁大学[6 例]）中心的 120 例接受 SRS 治疗的 dAVF 患者。使用逻辑回归分析评估了 SRS 后预后良好（无 SRS 后出血性闭塞）的预测因素。这些因素与文献系统评价中 7 项研究中发现的可预测闭塞的因素一起纳入逐步多元回归，以确定最佳拟合模型。
结果
基于预测模型，有 3 个因素出现，以建立 SRS 评分系统：皮质静脉回流（CVR）、既往颅内出血（ICH）和非海绵窦位置。I 级（0-1 分）预测预后最佳，良好结局的比例为 80%。II 级（2 分）患者的预后中等，良好结局的比例为 57%，III 级（3 分）患者的预后最差，良好结局的比例为 37%。ROC 分析显示，该评分系统对现有分级系统具有更好的预测能力（AUC=0.69；P=0.04）。Kaplan-Meier 分析显示，所提出的 SRS 后 dAVF 闭塞分级系统的 3 个亚组之间存在统计学显著差异（P=0.001）。
结论
所提出的 dAVF 分级系统纳入了血管造影、解剖和临床参数，与现有的评分系统相比，提高了对 SRS 后 dAVF 结局的预测能力。
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