Troude Lucas, Sahan Sihmehmet, Fischer Igor, Koeskemeier Pia Jr, Faust Katharina, Muhammad Sajjad
Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.
Department of Neurosurgery, North University Hospital, APHM-AMU Chemin Des Bourrely, 13015, Marseille, France.
Neurosurg Rev. 2025 Sep 5;48(1):632. doi: 10.1007/s10143-025-03757-x.
The treatment of unruptured & ruptured AVMs remains controversial. Microsurgical resection of the AVM offers the higher cure rate, but the associated morbidity and mortality may exceed that of the AVM's natural history. Single center retrospective cohort study of 120 consecutive patients harboring intracranial AVM operated on between January 2010 and June 2023. The AVM was ruptured in 68% of cases (mean hematoma volume 24,5 cc / median 16,5). Preoperatively, 39% of the patients presented with massive intracranial hemorrhage leading to elevated intracranial pressure, 24% with epilepsy and 31% with a motor paresis.. The initial Glasgow Coma Scale was less than 12 in 36% of cases in the ruptured AVM group. The AVM location was lobar in 81% of cases. The Spetzler-Martin grades were 1, 2, 3 and 4 in 26%, 41%, 15% and 1% of cases, respectively. Seventeen patients (14%) harbored an infratentorial AVM. The mean nidus diameter was 17 mm (range 5-55 / median 13 mm). All patients underwent surgical resection of the AVM. An external ventricular drainage was necessary in 25% of cases. Thirteen patients (11%) had received preoperative embolization. The occlusion rate was 89%. A nidus residue was shown on postoperative angiography in 13 patients (11%). Of those, 6 patients underwent a 2nd stage surgical treatment while 2 other (15%) had received a salvage embolization, with a 100% complete obliteration rate. The obliteration rate at discharge was 96%. Five patients harboring a residue were allocated to a Wait& Scan strategy. The Glasgow outcome scale was 5 in 68%, 4 in 14%, 3 in 8%, 2 in 7% of cases. Three patients (3%) died of ruptured AVM despite surgery. Low grade cranial AVMs can be safely managed surgically, with a high cure rate and satisfying outcome. The surgical resection of ruptured AVMs is significantly more challenging and associated with inferior obliteration rate and postoperative outcome.
未破裂和破裂动静脉畸形（AVM）的治疗仍存在争议。AVM的显微手术切除治愈率较高，但相关的发病率和死亡率可能超过AVM的自然病程。对2010年1月至2023年6月期间连续接受颅内AVM手术的120例患者进行单中心回顾性队列研究。68%的病例中AVM破裂（平均血肿体积24.5立方厘米/中位数16.5立方厘米）。术前，39%的患者出现大量颅内出血导致颅内压升高，24%的患者患有癫痫，31%的患者患有运动性麻痹。破裂AVM组中36%的病例初始格拉斯哥昏迷量表评分低于12分。81%的病例中AVM位于脑叶。Spetzler-Martin分级为1级、2级、3级和4级的病例分别占26%、41%、15%和1%。17例患者（14%）患有幕下AVM。平均病灶直径为17毫米（范围5 - 55毫米/中位数13毫米）。所有患者均接受了AVM的手术切除。25%的病例需要进行脑室外引流。13例患者（11%）接受了术前栓塞。栓塞率为89%。13例患者（11%）术后血管造影显示有病灶残留。其中，6例患者接受了二期手术治疗，另外2例（15%）接受了挽救性栓塞，完全闭塞率为100%。出院时的闭塞率为96%。5例有残留的患者被分配到等待观察策略。格拉斯哥预后量表评分为5分的病例占68%，评分为4分的占14%，评分为3分的占8%，评分为2分的占7%。3例患者（3%）尽管接受了手术，但仍死于破裂的AVM。低级别颅内AVM可以通过手术安全治疗，治愈率高且预后良好。破裂AVM的手术切除更具挑战性，且闭塞率和术后预后较差。
