Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
Neurosurg Rev. 2022 Aug;45(4):2909-2918. doi: 10.1007/s10143-022-01814-3. Epub 2022 May 20.
Seizures are the second most common manifestations of brain arteriovenous malformations (bAVMs). This study was conducted to investigate the clinical and angioarchitectural features of bAVMs with seizures and provide guidelines for the clinical management of these patients. We collected clinical and radiological data on patients with bAVMs diagnosed by digital subtraction angiography between January 2013 and December 2020 and dichotomized the patients into the seizures and non-seizures groups. We identified differences in demographic and angiographic features. Logistic regression and random forest (RF) models were developed and compared. The diagnostic capacity was assessed using receiver operating characteristic (ROC) curves. A nomogram was constructed, and the clinical impact was determined by decision curve analysis. A total of 414 patients with bAVMs were included in the analysis, of which 78 (18.8%) had bAVM-related seizures. In the multivariable logistic regression model, the location and side of bAVMs were independently associated with seizures. In RF models, the maximal diameter of veins and the cross-sectional area of feeding arteries and draining veins were the most important features. ROC curves showed that the RF model was not better than MLR in predicting seizures. Decision curve analysis revealed that the use of a constructed nomogram to stratify the seizure patients was beneficial at all threshold probabilities in our study. The side and location of bAVMs are specific angioarchitectural features independently associated with the occurrences of seizures with bAVMs.
癫痫发作是脑动静脉畸形（bAVM）的第二大常见表现。本研究旨在探讨伴癫痫发作的 bAVM 的临床和血管构筑特征，并为这些患者的临床管理提供指导。我们收集了 2013 年 1 月至 2020 年 12 月期间通过数字减影血管造影诊断为 bAVM 的患者的临床和影像学数据，并将患者分为癫痫发作组和非癫痫发作组。我们确定了人口统计学和血管造影特征的差异。我们建立了逻辑回归和随机森林（RF）模型，并进行了比较。使用接收者操作特征（ROC）曲线评估诊断能力。构建了列线图，并通过决策曲线分析确定了临床影响。共纳入 414 例 bAVM 患者进行分析，其中 78 例（18.8%）有 bAVM 相关癫痫发作。在多变量逻辑回归模型中，bAVM 的位置和侧别与癫痫发作独立相关。在 RF 模型中，静脉最大直径以及供血动脉和引流静脉的横截面积是最重要的特征。ROC 曲线显示，RF 模型在预测癫痫发作方面并不优于 MLR。决策曲线分析表明，在我们的研究中，使用构建的列线图对癫痫发作患者进行分层在所有阈值概率下均有益。bAVM 的侧别和位置是与 bAVM 相关的癫痫发作发生的特定血管构筑特征。
