1Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan.
2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing.
J Neurosurg. 2024 Mar 8;141(2):316-322. doi: 10.3171/2023.12.JNS231539. Print 2024 Aug 1.
Reducing the incidence of delayed postoperative hemorrhage (DPH) is one of the challenges in the surgical treatment of patients with brain arteriovenous malformations (bAVMs). This study aimed to identify several risk factors for DPH after bAVM resection and evaluate the impact of these risk factors in patients with bAVMs.
The authors retrospectively reviewed consecutive patients with bAVMs who underwent microsurgical resection between August 2011 and September 2021. Patients were divided into either the DPH group or non-DPH group based on whether they experienced a postoperative intracerebral hemorrhage into the bAVM bed within 14 days after bAVM resection. Factors associated with DPH were assessed using multivariate logistic regression analyses.
A total of 1284 consecutive patients with bAVMs were evaluated; DPH events occurred in 18 patients (1.4%). There were several differences in vascular architecture between the two cohorts. A giant nidus, a nidus involved in the eloquent area, a periventricular nidus, and a nidus accompanied by venous ectasia were more likely to be associated with DPH events. The multivariate analysis identified two independent factors associated with DPH: maximum diameter (OR 1.44 per 1-cm increase, 95% CI 1.13-1.83) and periventricular lesion (OR 4.10, 95% CI 1.33-12.59). The area under the receiver operating characteristic curve for the maximum lesion diameter and development of DPH was 0.71 (95% CI 0.58-0.84). The cutoff value for the maximum bAVM diameter was 4.15 cm. Furthermore, patients with a giant bAVM, of which the maximum diameter was ≥ 4.15 cm, had a higher DPH risk after surgery (HR 5.79, 95% CI 2.01-16.67; p < 0.01). The incidence rates of DPH for patients with periventricular lesions were higher than those for patients without periventricular lesions (HR 4.50, 95% CI 1.77-11.40; p < 0.01).
Patients with giant bAVMs or periventricular lesions are at higher risk for DPH after surgery. Strategies such as blood pressure control, preoperative embolization, intraoperative monitoring, and careful patient selection should be considered to reduce the risk of DPH in high-risk patients.
降低脑动静脉畸形（bAVM）患者术后迟发性出血（DPH）的发生率是手术治疗的挑战之一。本研究旨在确定 bAVM 切除术后 DPH 的几个风险因素，并评估这些风险因素对 bAVM 患者的影响。
作者回顾性分析了 2011 年 8 月至 2021 年 9 月间接受显微手术切除的连续 bAVM 患者。根据术后 14 天内 bAVM 切除术后是否发生颅内出血至 bAVM 床，患者分为 DPH 组或非 DPH 组。使用多变量逻辑回归分析评估与 DPH 相关的因素。
共评估了 1284 例连续 bAVM 患者，18 例（1.4%）发生 DPH 事件。两组患者的血管结构存在一些差异。大病灶、病灶累及功能区、脑室周围病灶和伴有静脉扩张的病灶更易发生 DPH 事件。多变量分析确定了与 DPH 相关的两个独立因素：最大直径（每增加 1cm，OR 1.44，95%CI 1.13-1.83）和脑室周围病变（OR 4.10，95%CI 1.33-12.59）。最大病变直径和 DPH 发生的受试者工作特征曲线下面积为 0.71（95%CI 0.58-0.84）。最大 bAVM 直径的截断值为 4.15cm。此外，最大直径≥4.15cm 的巨大 bAVM 患者术后 DPH 风险更高（HR 5.79，95%CI 2.01-16.67；p<0.01）。有脑室周围病变的患者的 DPH 发生率高于无脑室周围病变的患者（HR 4.50，95%CI 1.77-11.40；p<0.01）。
患有巨大 bAVM 或脑室周围病变的患者术后发生 DPH 的风险较高。应考虑控制血压、术前栓塞、术中监测和仔细选择患者等策略，以降低高危患者 DPH 的风险。
