Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and Tampere University, Tampere, Finland.
Dept of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
Neurosurg Rev. 2023 Apr 29;46(1):99. doi: 10.1007/s10143-023-02001-8.
Treatment for arteriovenous malformations of the brain (bAVMs) aims to achieve complete removal or occlusion of the lesion in order to eradicate the risk of rupture and subsequent morbidity associated with these lesions. Despite initially successful treatment, bAVMs may carry a risk of recurrence especially in younger patients. We studied the rate of recurrence of surgically treated bAVMs at Kuopio University Hospital (KUH) in 1981-2021. The study population was collected retrospectively from KUH databases and presented a cohort of 135 surgically treated bAVMs with complete occlusion of the lesion. We also performed a systematic literature review on this topic. In our series, 6 out of 135 (4.4%) patients with angiographically confirmed removal of the lesion later developed a recurrent bAVM with a median time to diagnosis of recurrence of 7.46 years. In pediatric patients, the rate was 5 out of 17 (29.4%). bAVM recurrence was associated with age (p = 0.001) and initial hemorrhagic presentation (p = 0.039). Median age of the study population was 37 years (min 0, max 70), and 51/135 (37.8%) of the patients were female. Seventeen (12.6%) of the 135 bAVM patients were considered pediatric (18 years old or younger) at the time of the operation. In the literature review, 79 of 1739 (4.5%) of surgically treated patients later developed a recurrence with a mean delay of 3.1 years until diagnosis of recurrence. Young surgically treated bAVM patients with a hemorrhagic presentation at initial diagnosis are at a relatively high risk of bAVM recurrence. Follow-up imaging should be arranged for these patients in order to prevent rupture from a recurrent bAVM and subsequent morbidity.
脑动静脉畸形（bAVM）的治疗旨在实现病变的完全切除或闭塞，以消除与这些病变相关的破裂风险和随后的发病率。尽管最初的治疗成功，bAVM 可能会有复发的风险，特别是在年轻患者中。我们研究了 1981 年至 2021 年在库奥皮奥大学医院（KUH）治疗的 bAVM 的复发率。该研究人群是从 KUH 数据库中回顾性收集的，共纳入 135 例手术治疗的完全闭塞病变 bAVM 患者。我们还对这一主题进行了系统的文献回顾。在我们的系列中，135 例接受血管造影证实的病变切除的患者中有 6 例（4.4%）后来出现了复发性 bAVM，诊断复发的中位时间为 7.46 年。在儿科患者中，这一比例为 17 例中的 5 例（29.4%）。bAVM 复发与年龄（p=0.001）和初始出血表现（p=0.039）有关。研究人群的中位年龄为 37 岁（最小 0 岁，最大 70 岁），135 例患者中有 51 例（37.8%）为女性。135 例 bAVM 患者中有 17 例（12.6%）在手术时被认为是儿科患者（18 岁或以下）。在文献回顾中，1739 例手术治疗的患者中有 79 例（4.5%）后来出现了复发，诊断复发的平均延迟时间为 3.1 年。初始诊断时有出血表现的年轻手术治疗 bAVM 患者复发的风险相对较高。应安排这些患者进行随访影像学检查，以防止复发性 bAVM 破裂和随后的发病率。
