Mooney James, Salehani Arsalaan, Erickson Nicholas, Thomas Evan, Ilyas Adeel, Rahm Sage, Eustace Nicholas, Maleknia Pedram, Yousuf Omer, Bredel Markus, Fiveash John, Dobelbower Chris, Fisher Winfield
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Surg Neurol Int. 2022 May 6;13:194. doi: 10.25259/SNI_86_2022. eCollection 2022.
There are a limited data examining the effects of prior hemorrhage on outcomes after stereotactic radiosurgery (SRS). The goal of this study was to identify risk factors for arteriovenous malformation (AVM) rupture and compare outcomes, including post-SRS hemorrhage, between patients presenting with ruptured and unruptured AVMs.
A retrospective review of consecutive patients undergoing SRS for intracranial AVMs between 2009 and 2019 at our institution was conducted. Chi-square and multivariable logistic regression analyses were utilized to identify patient and AVM factors associated with AVM rupture at presentation and outcomes after SRS including the development of recurrent hemorrhage in both ruptured and unruptured groups.
Of 210 consecutive patients with intracranial AVMs treated with SRS, 73 patients (34.8%) presented with AVM rupture. Factors associated with AVM rupture included smaller AVM diameter, deep venous drainage, cerebellar location, and the presence of intranidal aneurysms ( < 0.05). In 188 patients with adequate follow-up time (mean 42.7 months), the overall post-SRS hemorrhage rate was 8.5% and was not significantly different between ruptured and unruptured groups (10.3 vs. 7.5%, = 0.51). There were no significant differences in obliteration rate, time to obliteration, or adverse effects requiring surgery or steroids between unruptured and ruptured groups.
Smaller AVM size, deep venous drainage, and associated intranidal aneurysms were associated with rupture at presentation. AVM rupture at presentation was not associated with an increased risk of recurrent hemorrhage or other complication after SRS when compared to unruptured AVM presentation. Obliteration rates were similar between ruptured and unruptured groups.
关于既往出血对立体定向放射外科治疗（SRS）后疗效影响的数据有限。本研究的目的是确定动静脉畸形（AVM）破裂的危险因素，并比较破裂和未破裂AVM患者的治疗结果，包括SRS后出血情况。
对2009年至2019年在我院接受颅内AVM的SRS治疗的连续患者进行回顾性分析。采用卡方检验和多变量逻辑回归分析来确定与AVM破裂及SRS后疗效相关的患者及AVM因素，包括破裂组和未破裂组复发性出血的发生情况。
在210例接受SRS治疗的连续颅内AVM患者中，73例（34.8%）出现AVM破裂。与AVM破裂相关的因素包括AVM直径较小、深部静脉引流、小脑位置以及瘤巢内动脉瘤的存在（P<0.05）。188例有足够随访时间（平均42.7个月）的患者中，SRS后总体出血率为8.5%，破裂组和未破裂组之间无显著差异（10.3%对7.5%，P=0.51）。在闭塞率、闭塞时间或需要手术或使用类固醇的不良反应方面，未破裂组和破裂组之间无显著差异。
较小的AVM大小、深部静脉引流及相关的瘤巢内动脉瘤与AVM破裂有关。与未破裂的AVM相比，破裂的AVM在SRS后复发性出血或其他并发症的风险并未增加。破裂组和未破裂组的闭塞率相似。
