Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
Department of Neurosurgery, St Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Acta Neurochir Suppl. 2021;132:91-100. doi: 10.1007/978-3-030-63453-7_14.
Eloquent location of a brain arteriovenous malformation (BAVM) is known to increase the surgical risk. Surgical removal of such BAVMs is challenging. Useful indicators for the safe removal of eloquent BAVMs are needed. The aim of this study was to determine the surgical risk factors for these challenging entities.
The authors retrospectively reviewed 29 motor and/or sensory BAVM patients who underwent surgeries. The risk factors for surgical morbidity were analyzed. As a new risk factor, maximum nidus depth, was evaluated.
Complete obliteration was achieved in 28 patients (96.6%). Postoperative transient and permanent neurological deteriorations were seen in nine patients (31.0%) and five patients (17.2%), respectively. In univariate analysis, maximum nidus depth (p = 0.0204) and asymptomatic onset (p = 0.0229) were significantly correlated with the total morbidity. In multivariate analysis, only maximum nidus depth was significantly correlated with total morbidity (p = 0.0357; odds ratio, 2.78598; 95% confidence interval, 0.8866-8.7535). The cut-off value for the maximum nidus depth was 36 mm for total morbidity (area under the curve [AUC], 0.7428) and 41 mm for permanent morbidity (AUC, 0.8833). The cutoff value of the maximum nidus size was 30 mm for total morbidity (AUC, 0.5785) and 30 mm for permanent morbidity (AUC, 0.7625). AUC was higher for the maximum nidus depth than it was for the maximum nidus size.
Maximum nidus depth was significantly associated with surgical morbidity of eloquent BAVMs. The maximum nidus depth is a novel and a simpler indicator of the risk of surgical morbidity.
脑动静脉畸形（BAVM）的功能区位置已知会增加手术风险。此类 BAVM 的手术切除具有挑战性。需要有用的指标来安全切除功能区 BAVM。本研究旨在确定这些具有挑战性的实体的手术风险因素。
作者回顾性分析了 29 例接受手术的运动和/或感觉 BAVM 患者。分析了手术发病率的危险因素。评估了新的危险因素-最大病灶深度。
28 例患者（96.6%）达到完全闭塞。术后 9 例（31.0%）和 5 例（17.2%）患者出现短暂性和永久性神经功能恶化。单因素分析显示，最大病灶深度（p=0.0204）和无症状起病（p=0.0229）与总发病率显著相关。多因素分析显示，只有最大病灶深度与总发病率显著相关（p=0.0357；优势比，2.78598；95%置信区间，0.8866-8.7535）。最大病灶深度为 36mm 时总发病率的截断值（曲线下面积[AUC]，0.7428），最大病灶深度为 41mm 时永久性发病率的截断值（AUC，0.8833）。最大病灶大小的总发病率截断值为 30mm（AUC，0.5785），永久性发病率截断值为 30mm（AUC，0.7625）。最大病灶深度的 AUC 高于最大病灶大小。
最大病灶深度与功能区 BAVM 的手术发病率显著相关。最大病灶深度是手术发病率风险的一个新的、更简单的指标。
