Background: Intracranial hemorrhage is a serious possible complication in patients with brain arteriovenous malformation (AVM). Several morphologic factors associated with hemorrhagic AVM presentation have been establ...Background: Intracranial hemorrhage is a serious possible complication in patients with brain arteriovenous malformation (AVM). Several morphologic factors associated with hemorrhagic AVM presentation have been established, but their relevance for the risk of subsequent AVM hemorrhage remains unclear. Methods: The authors analyzed follow-up data on 622 consecutive patients from the prospective Columbia AVM database, limited to the period between initial AVM diagnosis and the start of treatment (i.e., any endovascular, surgical, or radiation therapy). Univariate and multivariate logistic regression and Cox proportional hazard models were applied to analyze the effect of patient age, gender, AVM size, anatomic location, venous drainage pattern, and associated arterial aneurysms on the risk of intracranial hemorrhage at initial presentation and during follow-up. Results: The mean pretreatment follow-up was 829 days (median: 102 days), during which 39 (6%) patients experienced AVM hemorrhage. Increasing age (hazard ratio [HR] 1.05, 95%CI 1.03 to 1.08), initial hemorrhagic AVM presentation (HR 5.38, 95%CI 2.64 to 10.96), deep brain location (HR 3.25, 95%CI 1.30 to 8.16), and exclusive deep venous drainage (HR 3.25, 95%CI 1.01 to 5.67) were independent predictors of subsequent hemorrhage. Annual hemorrhage rates on follow-up ranged from 0.9%for patients without hemorrhagic AVM presentation, deep AVM location, or deep venous drainage to as high as 34.4%for those harboring all three risk factors. Conclusions: Hemorrhagic arteriovenous malformation (AVM) presentation, increasing age, deep brain location, and exclusive deep venous drainage appear to be independent predictors for AVM hemorrhage during natural history follow-up. The risk of spontaneous hemorrhage may be low in AVMs without these risk factors.展开更多
Background and Purpose -Therapy of brain arteriovenous malformations (AVMs) often requires the combination of different treatment modalities. Independently assessed data on neurologic outcome after multidisciplinary A...Background and Purpose -Therapy of brain arteriovenous malformations (AVMs) often requires the combination of different treatment modalities. Independently assessed data on neurologic outcome after multidisciplinary AVM therapy are scarce. Methods -The 119 consecutive patients (49%women, mean age 34±13 years) with brain AVMs receiving endovascular embolization followed by surgical treatment were analyzed. Neurologic impairment was assessed prospectively by a neurologist using the modified Rankin Scale (mRS) before, during, and after completed AVM therapy. The association of demographic, clinical, and morphologic characteristics with new treatment-related neurologic deficits was calculated. Results -The 119 patients were treated with 240 superselective embolizations (median, 2; range, 1 to 8) using n-butyl cyanoacrylate. Mean follow-up time after surgery was 9.6±13.2 months. On the Spetzler-Martin scale, 8%of the AVMs were grade 1, 27%grade 2, 40%grade 3, 22%grade 4, and 3%grade 5. Disabling treatment-related complications (mRS≥3) occurred in 5%(95%confidence interval [CI], 1%to 9%) of the patients. Nondisabling new deficits were observed in another 42%(95%CI, 33%to 51%). No patient died. Nonhemorrhagic AVM presentation (odds ratio [OR], 5.00; 95%CI, 1.75 to 14.29), deep venous drainage (OR, 3.09; 95%CI, 1.43 to 6.64), AVM location in an eloquent brain region (OR, 2.42; 95%CI, 1.10 to 5.33), and large AVM size (OR, 1.05; 95%CI, 1.01 to 1.09) were independently associated with new treatment-related deficits. Conclusions -Our results suggest an increased treatment risk for patients with previously unbled AVMs from combined endovascular and surgical AVM therapy. Additional risk factors for treatment-related neurologic deficits may be large AVM size, deep venous drainage, and AVM location in eloquent brain regions.展开更多
文摘Background: Intracranial hemorrhage is a serious possible complication in patients with brain arteriovenous malformation (AVM). Several morphologic factors associated with hemorrhagic AVM presentation have been established, but their relevance for the risk of subsequent AVM hemorrhage remains unclear. Methods: The authors analyzed follow-up data on 622 consecutive patients from the prospective Columbia AVM database, limited to the period between initial AVM diagnosis and the start of treatment (i.e., any endovascular, surgical, or radiation therapy). Univariate and multivariate logistic regression and Cox proportional hazard models were applied to analyze the effect of patient age, gender, AVM size, anatomic location, venous drainage pattern, and associated arterial aneurysms on the risk of intracranial hemorrhage at initial presentation and during follow-up. Results: The mean pretreatment follow-up was 829 days (median: 102 days), during which 39 (6%) patients experienced AVM hemorrhage. Increasing age (hazard ratio [HR] 1.05, 95%CI 1.03 to 1.08), initial hemorrhagic AVM presentation (HR 5.38, 95%CI 2.64 to 10.96), deep brain location (HR 3.25, 95%CI 1.30 to 8.16), and exclusive deep venous drainage (HR 3.25, 95%CI 1.01 to 5.67) were independent predictors of subsequent hemorrhage. Annual hemorrhage rates on follow-up ranged from 0.9%for patients without hemorrhagic AVM presentation, deep AVM location, or deep venous drainage to as high as 34.4%for those harboring all three risk factors. Conclusions: Hemorrhagic arteriovenous malformation (AVM) presentation, increasing age, deep brain location, and exclusive deep venous drainage appear to be independent predictors for AVM hemorrhage during natural history follow-up. The risk of spontaneous hemorrhage may be low in AVMs without these risk factors.
文摘Background and Purpose -Therapy of brain arteriovenous malformations (AVMs) often requires the combination of different treatment modalities. Independently assessed data on neurologic outcome after multidisciplinary AVM therapy are scarce. Methods -The 119 consecutive patients (49%women, mean age 34±13 years) with brain AVMs receiving endovascular embolization followed by surgical treatment were analyzed. Neurologic impairment was assessed prospectively by a neurologist using the modified Rankin Scale (mRS) before, during, and after completed AVM therapy. The association of demographic, clinical, and morphologic characteristics with new treatment-related neurologic deficits was calculated. Results -The 119 patients were treated with 240 superselective embolizations (median, 2; range, 1 to 8) using n-butyl cyanoacrylate. Mean follow-up time after surgery was 9.6±13.2 months. On the Spetzler-Martin scale, 8%of the AVMs were grade 1, 27%grade 2, 40%grade 3, 22%grade 4, and 3%grade 5. Disabling treatment-related complications (mRS≥3) occurred in 5%(95%confidence interval [CI], 1%to 9%) of the patients. Nondisabling new deficits were observed in another 42%(95%CI, 33%to 51%). No patient died. Nonhemorrhagic AVM presentation (odds ratio [OR], 5.00; 95%CI, 1.75 to 14.29), deep venous drainage (OR, 3.09; 95%CI, 1.43 to 6.64), AVM location in an eloquent brain region (OR, 2.42; 95%CI, 1.10 to 5.33), and large AVM size (OR, 1.05; 95%CI, 1.01 to 1.09) were independently associated with new treatment-related deficits. Conclusions -Our results suggest an increased treatment risk for patients with previously unbled AVMs from combined endovascular and surgical AVM therapy. Additional risk factors for treatment-related neurologic deficits may be large AVM size, deep venous drainage, and AVM location in eloquent brain regions.
