Department of Neurosurgery, Baylor College of Medicine Medical Center, Houston, Texas.
Department of Neurological Surgery, University of California, San Francisco, California.
Neurosurg Focus. 2020 Oct 1;49(4):E9. doi: 10.3171/2020.7.FOCUS20464.
OBJECTIVE: Studies of resection of brain arteriovenous malformations (AVMs) in the elderly population are scarce. This study examined factors influencing patient selection and surgical outcome among elderly patients. METHODS: Patients 65 years of age and older who underwent resection of an unruptured or ruptured brain AVM treated by two surgeons at two centers were identified. Patient demographic characteristics, AVM characteristics, clinical presentation, and outcomes measured using the modified Rankin Scale (mRS) were analyzed. For subgroup analyses, patients were dichotomized into two age groups (group 1, 65-69 years old; group 2, ≥ 70 years old). RESULTS: Overall, 112 patients were included in this study (group 1, n = 61; group 2, n = 51). Most of the patients presented with hemorrhage (71%), a small nidus (< 3 cm, 79%), and a low Spetzler-Martin (SM) grade (grade I or II, 63%) and were favorable surgical candidates according to the supplemented SM grade (supplemented SM grade < 7, 79%). A smaller AVM nidus was statistically significantly more likely to be present in patients with infratentorial AVMs (p = 0.006) and with a compact AVM nidus structure (p = 0.02). A larger AVM nidus was more likely to be treated with preoperative embolization (p < 0.001). Overall outcome was favorable (mRS scores 0-3) in 71% of the patients and was statistically independent from age group or AVM grading. Patients with ruptured AVMs at presentation had significantly better preoperative mRS scores (p < 0.001) and more favorable mRS scores at the last follow-up (p = 0.04) than patients with unruptured AVMs. CONCLUSIONS: Outcomes were favorable after AVM resection in both groups of patients. Elderly patients with brain AVMs treated microsurgically were notable for small nidus size, AVM rupture, and low SM grades. Microsurgical resection is an important treatment modality for elderly patients with AVMs, and supplemented SM grading is a useful tool for the selection of patients who are most likely to achieve good neurological outcomes after resection. ABBREVIATIONS: AVM = arteriovenous malformation; BNI = Barrow Neurological Institute; LY = Lawton-Young; mRS = modified Rankin Scale; SM = Spetzler-Martin; supp-SM = supplemented SM; UCSF = University of California, San Francisco.
目的：研究老年人脑动静脉畸形（AVM）切除术的文献较少。本研究旨在探讨影响老年患者选择和手术结果的因素。
方法：确定两位外科医生在两个中心治疗的未破裂或破裂脑 AVM 切除术的 65 岁及以上患者。分析患者的人口统计学特征、AVM 特征、临床表现和改良 Rankin 量表（mRS）测量的结果。对于亚组分析，患者分为两组（年龄组 1：65-69 岁；年龄组 2：≥70 岁）。
结果：本研究共纳入 112 例患者（年龄组 1：61 例；年龄组 2：51 例）。大多数患者表现为出血（71%）、小病灶（＜3cm，79%）和低斯佩泽尔-马丁（SM）分级（I 级或 II 级，63%），根据补充 SM 分级（补充 SM 分级＜7 级，79%）为良好的手术候选者。幕下 AVM（p=0.006）和 AVM 病灶结构紧密（p=0.02）患者更可能存在较小的 AVM 病灶。较大的 AVM 病灶更可能需要术前栓塞（p＜0.001）。总体预后良好（mRS 评分 0-3）的患者占 71%，且与年龄组或 AVM 分级无关。表现为破裂性 AVM 的患者术前 mRS 评分明显更好（p＜0.001），末次随访时 mRS 评分更有利（p=0.04），而非破裂性 AVM 患者。
结论：两组患者的 AVM 切除术后结果均良好。经显微镜手术治疗的老年 AVM 患者的特点是病灶小、AVM 破裂和低 SM 分级。显微镜下切除是 AVM 老年患者的重要治疗方法，补充 SM 分级是选择切除后获得良好神经功能结局可能性最大患者的有用工具。
缩写：AVM = 动静脉畸形；巴罗神经学研究所（Barrow Neurological Institute）；LY = 劳顿-杨；mRS = 改良 Rankin 量表；SM = 斯佩泽尔-马丁；suppl-SM = 补充 SM；加利福尼亚大学旧金山分校（University of California, San Francisco）。
Neurosurg Focus. 2020-10-1
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