Naranbhai Nitesh, Pérez Raúl
Department of Neuroscience, School of Advanced Education Research and Accreditation (SAERA), Universidad Isabel I, Burgos, ESP.
Department of Neurosurgery, Robert Mangaliso Sobukwe Hospital, Kimberley, ZAF.
Cureus. 2023 Jan 22;15(1):e34053. doi: 10.7759/cureus.34053. eCollection 2023 Jan.
Brain arteriovenous malformations (bAVM) are vascular malformations of the brain affecting all ages. The optimum management strategy is essentially devoid of high-quality evidence and is highly nuanced and embedded in local customs. This study summarizes the frequently employed management strategies, drawing conclusions on the utility of each method of treatment and delving into controversies surrounding them. A literature search on PubMed and Medline was done on January 3, 2022. 11,767 articles were found, and abstracts were reviewed. Full-text review of 153 articles led to chapters from three books and 71 articles incorporated into a summative discussion. Spetzler-Ponce (S-P) Class A patients may be offered surgery if they are good surgical candidates and have a good number of high-quality years of life left. The exception is diffuse Spetzler-Martin (S-M) grade 2 in a patient older than 40 years: radiosurgery for unruptured and embolization for ruptured. S-P Class B may be offered surgery if a compact nidus or if younger than 40 years. If diffuse or age greater than 40, radiosurgery may be preferred if the Pollock-Flickinger score is less than 2.5. For the remainder of S-P Class B, conservative management may be preferred. S-P Class C is generally not treated unless young or those patients with poorly controlled seizures affecting their quality of life are willing to risk permanent neurological deficits. While the quality of studies is generally high, the level of evidence is concerning with only one randomized controlled trial (RCT). Most research output hails from high-income countries, i.e., perhaps not universally applicable to all settings owing to possible genetic, environmental, and resource differences. More research is needed: large volume studies in the pregnant population, validation of scoring systems in pediatric age groups, clinical trials focused on combination multi-staged treatment modalities, and studies originating from the developing world.
脑动静脉畸形（bAVM）是一种影响各年龄段的脑血管畸形。最佳治疗策略基本上缺乏高质量证据，且非常微妙，还深受当地习俗影响。本研究总结了常用的治疗策略，对每种治疗方法的效用得出结论，并深入探讨围绕这些方法的争议。于2022年1月3日在PubMed和Medline上进行了文献检索。共找到11767篇文章，并对摘要进行了审查。对153篇文章的全文审查产生了三本书的章节以及71篇文章，这些被纳入总结性讨论。如果Spetzler-Ponce（S-P）A类患者是良好的手术候选者且还有大量高质量的剩余生命年，则可考虑手术治疗。40岁以上患者弥漫性Spetzler-Martin（S-M）2级是个例外：未破裂者采用放射外科治疗，破裂者采用栓塞治疗。如果S-P B类患者有致密的病灶或年龄小于40岁，可考虑手术治疗。如果是弥漫性的或年龄大于40岁，且Pollock-Flickinger评分小于2.5，则可能更倾向于放射外科治疗。对于其余的S-P B类患者，可能更倾向于保守治疗。S-P C类患者一般不进行治疗，除非患者年轻或那些癫痫控制不佳影响生活质量且愿意冒永久性神经功能缺损风险的患者。虽然研究质量总体较高，但证据水平令人担忧，仅有一项随机对照试验（RCT）。大多数研究成果来自高收入国家，也就是说，由于可能存在的基因、环境和资源差异，可能并非普遍适用于所有情况。还需要更多研究：针对孕妇群体的大规模研究、儿科年龄组评分系统的验证、专注于联合多阶段治疗模式的临床试验，以及来自发展中世界的研究。
