Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience

被引：72

作者：

da Costa, L. ^{[1
,2
,5
,6
]}

Thines, L. ^{[3
,4
,7
]}

Dehdashti, A. R. ^{[3
,4
,7
]}

Wallace, M. C. ^{[3
,4
]}

Willinsky, R. A. ^{[2
,4
,6
,7
]}

Tymianski, M. ^{[3
,4
,7
]}

Schwartz, M. L. ^{[1
,4
,5
]}

ter Brugge, K. G. ^{[2
,4
,6
]}

da Costa, L. ^{[1
,2
,5
,6
]}

Thines, L. ^{[3
,4
,7
]}

Dehdashti, A. R. ^{[3
,4
,7
]}

Wallace, M. C. ^{[3
,4
]}

Willinsky, R. A. ^{[2
,4
,6
,7
]}

Tymianski, M. ^{[3
,4
,7
]}

Schwartz, M. L. ^{[1
,4
,5
]}

ter Brugge, K. G. ^{[2
,4
,6
]}

机构：

[1] Univ Toronto, Sunnybrook Hosp, Dept Surg, Div Neurosurg, 2075 Bayview Ave,Suite A1-37, Toronto, ON M4N 3M5, Canada

[2] Univ Toronto, Toronto Western Hosp, Dept Med Imaging, Div Neuroradiol, Toronto, ON M4N 3M5, Canada

[3] Univ Toronto, Toronto Western Hosp, Dept Surg, Div Neurosurg, Toronto, ON M4N 3M5, Canada

[4] Toronto Brain Vasc Malformat Study Grp, Toronto, ON, Canada

[5] Univ Toronto, Div Neurosurg, Sunnybrook Hosp, Dept Surg, Toronto, ON M4N 3M5, Canada

[6] Univ Toronto, Div Neuroradiol, Dept Med Imaging, Toronto Western Hosp, Toronto, ON M4N 3M5, Canada

[7] Univ Toronto, Dept Surg, Toronto Western Hosp, Toronto, ON, Canada

来源：

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY | 2009年 / 80卷 / 04期

关键词：

ARTERIAL ANEURYSMS; INTRACRANIAL HEMORRHAGE; MULTIMODALITY TREATMENT; BASAL GANGLIA; RADIOSURGERY; RISK; THALAMUS;

D O I：

10.1136/jnnp.2008.152710

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Objectives: Posterior fossa brain arteriovenous malformations (PFbAVMs) are rare lesions. Management is complicated by eloquence of adjacent neurological structures, multimodality treatment is often necessary, and obliteration is not always possible. We describe a 15-year experience in the management of posterior fossa brain AVMs with a focus on clinical outcome. Methods: From 1989 to 2004, prospectively collected information on 106 patients with diagnosis of a PFbAVMs was obtained. Clinical and angioarchitectural characteristics, management options and complications are described and reviewed to evaluate their impact on final outcome as measured by the Modified Rankin Score (mRS). Results: Ninety-eight patients were followed for an average of 3.3 years (1-14.6). The male-to-female ratio was 1:1. Ninety-five out of 98 patients (96.9%) were symptomatic at presentation, with 61 (62.2%) intracranial haemorrhages. Sixty-two patients were treated (46 cerebellar, 16 brainstem). Ten haemorrhages occurred in follow-up (4.1%/ year). The mRS was obtained in 62 patients and was classified as low (good, mRS(2) or high (poor, mRS >= 3). Haemorrhage was the only predictor of poor mRS at presentation (p=0.0229). A poor clinical outcome was correlated with the presence of AA (p=0.0276), a poor initial mRS (p<0.0001) and the number of treatments needed (p=0.0434). Patients were significantly more likely to improve than to deteriorate over time (p=0.0201). Conclusion: The final clinical outcome in PFbAVMs relates directly with the presence of associated aneurysms, number of treatments needed to obliterate the AVM and mRS at presentation. Despite the fact that patients tend to improve after brain AVM haemorrhage, the relationship of MRS at presentation and final outcome suggests that an expedited, more definitive treatment is probably a better choice, especially in patients with good grades after the initial bleeding.

引用

页码：376 / 379

页数：4

共 33 条

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