Maalim Ali Abdi, Zhu Mingxin, Shu Kai, Wu Yasong, Zhang Suojun, Ye Fei, Zeng Ying, Huang Yimin, Lei Ting
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Brain Sci. 2023 Aug 10;13(8):1183. doi: 10.3390/brainsci13081183.
The purpose of the study was to assess the functional outcomes after microsurgical resection of arteriovenous malformations (AVMs) and to compare the results between patients eligible for A Randomized Trial of Unruptured Brain Arteriovenous Malformations in this surgical series to the results reported and the ARUBA study.
We reviewed the records of 169 patients who underwent microsurgical treatment of arteriovenous malformation (AVMs) in our institution between January 2016 and December 2021. These patients' functional status was assessed using modified Rankin Scale (mRS) scores at the last follow-up and before treatment. The mRS scores at the latest follow-up were classified into good outcomes (mRS < 3) and poor outcomes (mRS ≥ 3). Clinical presentation, patients' demographics, AVM characteristics, follow-up time, and obliteration rate were analyzed. Subgroup analyses were performed on the whole cohort, comparing Spetzler-Martin Grade I and Grade II, and ARUBA-eligible AVMs.
The initial hemorrhagic presentation occurred in 71 (42%) out of 169 patients. The majority of the patients presented with headaches (73%). The AVMs were completely obliterated in 166 (98.2%) patients. The series included 65 Spetzler-Martin Grade I (38.5%), 46 Grade II (27.2%), 32 Grade III (18.9%), 22 Grade IV (13%), and 4 Grade V (2.4%) AVMs. There were 98 unruptured and 79 ARUBA-eligible cases. Also, optimal functional outcome was achieved in 145 (85.8%) patients. The overall mortality rate was 5.3% (9/169). The multivariate analysis illustrated that a poor outcome was significantly associated with presurgical mRS ≥3 ( < 0.013; OR, 0.206; 95% CI 0.059-0.713), increasing age ( < 0.045; odds ratio [OR], 1.022; 95% CI 1.000-0.045), and female gender ( < 0.009; OR, 2.991; 95% CI 1.309-6.832).
Our study suggests that better outcomes can be obtained using microsurgical resection in the majority of patients with AVMs. Independent predictors of poor outcomes after surgical resection of AVMs include increasing age at the time of surgery, poor presurgical functional status, and female gender. Supposing that patients are more suitable for microsurgery after presurgical examination, outcomes are normally better in that case than those achieved by multimodal interventions (such as conservative treatment or ARUBA treatment arm). Therefore, we recommend early surgical removal on all surgically accessible AVMs to prevent successive hemorrhages and the consequences of poor neurological outcomes.
本研究旨在评估显微手术切除动静脉畸形（AVM）后的功能结局，并将本手术系列中符合未破裂脑动静脉畸形随机试验条件的患者结果与已报道的结果及ARUBA研究结果进行比较。
我们回顾了2016年1月至2021年12月期间在我院接受动静脉畸形（AVM）显微手术治疗的169例患者的记录。在末次随访时和治疗前，使用改良Rankin量表（mRS）评分评估这些患者的功能状态。将末次随访时的mRS评分分为良好结局（mRS<3）和不良结局（mRS≥3）。分析临床表现、患者人口统计学特征、AVM特征、随访时间和闭塞率。对整个队列进行亚组分析，比较Spetzler-Martin I级和II级以及符合ARUBA标准的AVM。
169例患者中有71例（42%）最初表现为出血。大多数患者表现为头痛（73%）。166例（98.2%）患者的AVM完全闭塞。该系列包括65例Spetzler-Martin I级（38.5%）、4例II级（27.2%）、32例III级（18.9%）、22例IV级（13%）和4例V级（2.4%）的AVM。有98例未破裂病例和79例符合ARUBA标准的病例。此外，145例（85.8%）患者获得了最佳功能结局。总死亡率为5.3%（9/169）。多变量分析表明，不良结局与术前mRS≥3（<0.013；OR，0.206；95%CI 0.059-0.713）、年龄增加（<0.045；优势比[OR]为1.022；95%CI 1.000-0.045）和女性性别（<0.009；OR，2.991；95%CI 1.309-6.832）显著相关。
我们的研究表明，大多数AVM患者采用显微手术切除可获得更好的结局。AVM手术切除后不良结局的独立预测因素包括手术时年龄增加、术前功能状态差和女性性别。假设患者在术前检查后更适合显微手术，那么在这种情况下的结局通常比多模式干预（如保守治疗或ARUBA治疗组）所取得的结局更好。因此，我们建议对所有可手术切除的AVM尽早进行手术切除，以防止连续出血及神经功能不良后果。
