Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
BMC Neurol. 2020 Nov 5;20(1):404. doi: 10.1186/s12883-020-01987-8.
Despite rapid developments in devices used to treat arteriovenous malformation (AVM), a randomised trial of Unruptured Brain Arteriovenous malformations published in 2014 recommended conservative treatment for nonhemorrhagic AVM. The purpose of the current retrospective study was to confirm how AVM treatment in Japan has changed and to assess the safety of treatment for hemorrhagic and nonhemorrhagic AVMs.
We enrolled 242 consecutive patients with AVM; each patient's treatment was selected and performed at our hospital. The type of onset, Spetzler-Martin (S-M) grade, age, sex, selected treatment, mortality, and morbidity were compared between the first and second periods of our study.
In patients with grade I-III AVM, the selected treatment changed between the first and second periods; however, in grade IV and V patients, the selected treatment did not change. Overall, interventions by microsurgery alone decreased (p < 0.001), the proportion of total treatments including microsurgery decreased (p = 0.005), interventions using stereotactic radiosurgery (SRS) alone increased (p = 0.009), and interventions including SRS increased (p = 0.002). Morbidity associated with intervention was 0.92% in the first period and 0% in the second period, and mortality was 0.92% in the first period and 1.67% in the second.
With the development of new devices, the selected treatment was changed in patients with S-M grade I-III AVM, but was not changed in patients with grade IV and V. The complication rate was low and did not change throughout the periods. These findings suggest that the safety of treatment depends on a full understanding of device development and the selection of proper treatment, not on hemorrhagic onset. Further treatment innovations are expected to change the treatment for grade IV and V AVMs.
尽管用于治疗动静脉畸形（AVM）的设备发展迅速，但 2014 年发表的一项针对未破裂脑动静脉畸形的随机试验建议对非出血性 AVM 进行保守治疗。本回顾性研究的目的是确认日本的 AVM 治疗方法发生了怎样的变化，并评估治疗出血性和非出血性 AVM 的安全性。
我们纳入了 242 例连续的 AVM 患者；每位患者的治疗均在我院选择并进行。比较了本研究的第一和第二期之间患者的发病类型、Spetzler-Martin（S-M）分级、年龄、性别、选择的治疗、死亡率和发病率。
在 S-M 分级 I-III 的患者中，选择的治疗方法在第一和第二期之间发生了变化；然而，在 S-M 分级 IV 和 V 的患者中，选择的治疗方法没有变化。总体而言，单纯手术干预减少（p<0.001），包括手术的总治疗比例减少（p=0.005），单纯立体定向放射外科（SRS）干预增加（p=0.009），包括 SRS 的干预增加（p=0.002）。第一期介入相关发病率为 0.92%，第二期为 0%，第一期死亡率为 0.92%，第二期为 1.67%。
随着新设备的发展，S-M 分级 I-III 的 AVM 患者的选择治疗方法发生了变化，但 S-M 分级 IV 和 V 的患者的治疗方法没有变化。并发症发生率低，整个时期没有变化。这些发现表明，治疗的安全性取决于对设备发展的充分了解和适当治疗的选择，而不是出血的发生。进一步的治疗创新有望改变 S-M 分级 IV 和 V 的 AVM 的治疗方法。
