Department of Neurosurgery, Beijing Tiantan hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Neurosurg Rev. 2024 Jul 24;47(1):347. doi: 10.1007/s10143-024-02593-9.
Microsurgical resection is an effective method to treat brain arteriovenous malformations (BAVMs). Functional magnetic resonance imaging (fMRI) can evaluate the spatial relationship of nidus and eloquent. Diffuse BAVMs are related to poor outcomes postoperatively. The role of fMRI in evaluating outcomes in patients with different nidus types remains unclear. BAVM patients received microsurgical resection were included from a prospective, multicenter cohort study. All patients underwent fMRI evaluation preoperatively and were regularly followed up postoperatively. Diffuse BAVM is radiologically identified as nidus containing normal brain tissue interspersing between malformed vessels. Lesion-to-eloquent distance (LED) was calculated based on the relationship between nidus and eloquent. The primary outcome was 180-day unfavorable neurological status postoperatively. The risk of primary outcome was investigated within different BAVM nidus types. The LED's performance to predict poor outcome was evaluated using area under curve (AUC). 346 BAVM patients were included in this study. 93 (26.9%) patients were found to have a 180-day unfavorable outcome. Multivariate logistic analysis demonstrated LED (odd ratio [OR], 0.44; 0.34-0.57; P < 0.001) and mRS at admission (OR, 2.59; 1.90-3.54; P < 0.001) as factors of unfavorable outcome. Subgroup analysis showed LED and mRS at admission as factors of unfavorable outcome for patients with compact BAVMs (all P < 0.05), but not for patients with diffuse BAVMs. Subsequent analysis showed that LED performed poorly to predict the unfavorable outcome for patients with diffuse BAVMs, compared with patients with compact BAVMs (AUC as 0.69 vs. 0.86, P < 0.05). A larger cutoff value of LED to unfavorable outcome was found in patients with diffuse BAVMs (15 mm) compared with patients with compact BAVMs (4.7 mm). Usage of LED to evaluate postoperative outcome of patients with diffuse BAVMs differs from its use in patients with compact BAVMs. Specific assessment strategy considering BAVM nidus types could help improve patients' outcome. MITASREAVM cohort (unique identifier: NCT02868008, https://clinicaltrials.gov/study/NCT02868008?term=NCT02868008&rank=1 ).
显微外科切除是治疗脑动静脉畸形（BAVMs）的有效方法。功能磁共振成像（fMRI）可评估病灶和功能区之间的空间关系。弥漫性 BAVM 与术后不良预后相关。fMRI 在评估不同病灶类型患者的预后中的作用尚不清楚。从前瞻性多中心队列研究中纳入接受显微外科切除术的 BAVM 患者。所有患者术前均行 fMRI 评估，并定期随访术后情况。弥漫性 BAVM 在影像学上表现为病灶内含有正常脑组织，其间散布着畸形血管。根据病灶与功能区的关系计算病灶-功能区距离（LED）。主要转归为术后 180 天不良神经状态。在不同的 BAVM 病灶类型中探讨了原发结局的风险。使用曲线下面积（AUC）评估 LED 预测不良结局的性能。本研究纳入了 346 例 BAVM 患者。93 例（26.9%）患者术后 180 天预后不良。多变量 logistic 分析显示 LED（比值比 [OR]，0.44；0.34-0.57；P<0.001）和入院时 mRS（OR，2.59；1.90-3.54；P<0.001）是不良结局的因素。亚组分析显示，LED 和入院时 mRS 是致密型 BAVM 患者不良结局的因素（均 P<0.05），但不是弥漫型 BAVM 患者的不良结局因素。进一步分析显示，与致密型 BAVM 患者相比，LED 对弥漫型 BAVM 患者不良结局的预测能力较差（AUC 为 0.69 比 0.86，P<0.05）。弥漫型 BAVM 患者不良结局的 LED 截断值较大（15mm），而致密型 BAVM 患者的截断值较小（4.7mm）。LED 用于评估弥漫性 BAVM 患者术后结局的使用方法与用于评估致密性 BAVM 患者术后结局的方法不同。考虑 BAVM 病灶类型的特定评估策略可能有助于改善患者的结局。MITASREAVM 队列（唯一标识符：NCT02868008，https://clinicaltrials.gov/study/NCT02868008?term=NCT02868008&rank=1）。
