1Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee.
2Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
Neurosurg Focus. 2022 Jul;53(1):E17. doi: 10.3171/2022.4.FOCUS22123.
Head and neck arteriovenous malformations (AVMs) are complex lesions that represent a subset of vascular anomalies (VAs). The authors present an analysis of their institutional experience managing these lesions as a multidisciplinary team.
A retrospective chart review was performed of head and neck AVM patients treated at the authors' institution from 2012 to 2022. Recorded data included patient demographic characteristics, details of clinical presentation, Schöbinger clinical scale and Yakes AVM classification results, and details of all endovascular and surgical treatments. The primary outcome of the study was clinical response to treatment. Angiographic occlusion and complication rates were reported. Chi-square tests were used for comparative statistics.
Sixteen patients (9 female, 56%) with AVMs of the head and neck presented from age 3 to 77 years. The Schöbinger stage was stage II in 56% of patients (n = 9) and stage III in 44% of patients (n = 7). The Yakes AVM classification was nidus type (2a, 2b, or 4) in 7 patients (43%) and fistula type (1, 3a, or 3b) in 9 patients (57%). The majority of patients (n = 11, 69.0%) were managed with embolization as the only treatment modality, with an average of 1.5 embolizations/patient (range 1-3). Surgical resection was employed in 5 patients (4 in combination with embolization). Symptom resolution and symptom control were achieved in 69% and 31% of patients, respectively, in the entire cohort. A radiographic cure was demonstrated in 50% of patients. There were no statistical differences in clinical outcomes or radiographic cure rates between patients treated with different modalities.
Head and neck AVMs can be treated successfully with a primarily endovascular management strategy by a multidisciplinary team with the goal of symptomatic control.
头颈部动静脉畸形（AVM）是一种复杂的病变，属于血管畸形（VA）的一个亚类。作者分析了他们作为多学科团队管理这些病变的经验。
对作者所在机构 2012 年至 2022 年治疗的头颈部 AVM 患者进行回顾性病历分析。记录的数据包括患者的人口统计学特征、临床表现细节、Schöbinger 临床量表和 Yakes AVM 分类结果，以及所有血管内和手术治疗的细节。本研究的主要结局是治疗的临床反应。报告了血管造影闭塞和并发症的发生率。采用卡方检验进行比较统计学分析。
16 例（9 名女性，56%）头颈部 AVM 患者年龄 3 至 77 岁。Schöbinger 分期Ⅱ期 56%（9 例），Ⅲ期 44%（7 例）。Yakes AVM 分类为病灶型（2a、2b 或 4）7 例（43%），瘘管型（1、3a 或 3b）9 例（57%）。大多数患者（n=11，69.0%）仅接受栓塞治疗作为单一治疗方式，平均每个患者栓塞 1.5 次（范围 1-3）。5 例患者（4 例与栓塞联合）行手术切除。整个队列中，69%的患者症状缓解，31%的患者症状得到控制。50%的患者显示影像学治愈。不同治疗方式的患者在临床结局或影像学治愈方面无统计学差异。
头颈部 AVM 可通过多学科团队的主要血管内治疗策略成功治疗，目标是控制症状。
