Lingtong Liu1, Hao Li, Jian Zheng, Shuo Wang, Jizong Zhao, Yong Cao. 1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen District, Beijing, 100050, China, liulingtong21@yahoo.com.cn.
Abstract
BACKGROUND AND OBJECTIVE: Sylvian fissure arteriovenous malformations (AVMs) are among the most challenging AVMs to manage surgically. The estimates of their risk factors and prediction of their long-term prognosis are crucial for clinical decision-making. The authors conducted a retrospective review to patients with sylvian AVMs treated microsurgically to evaluate the risk factors associated with long-term prognosis. METHODS: Forty-one patients with sylvian fissure AVMs treated microsurgically between June 2009 and December 2011 were retrospectively reviewed with a mean follow-up time of 23 months (range 6-35 months). Chi-square test was utilized to compare proportions and rank-sum test to compare ordinal materials. Odds ratios (ORs) were used to assess risk factors associated with postoperative short-term outcome and long-term adverse outcome (mRS scores 3-6). RESULTS: One patient died in 1 month after surgery. Eighteen (43.9%) patients had postoperative transient neurological deterioration. Good outcomes (mRS scores 0-2) were observed in 29 (72.5%) patients in the follow-up. From the multiple logistic regression, a history of AVM bleeding and deep venous drainage increase the risk of postoperative transient neurological deterioration, with OR = 8.211 and OR = 4.869, respectively. A history of AVM bleeding was a risk factor for long-term adverse outcome, with OR = 7. CONCLUSIONS: Despite different Sugita classification subtypes, sylvian fissure AVMs' long-term results with microsurgical resection are better than expected; a history of AVM bleeding is a risk factor for postoperative temporary neurological deterioration and for long-term adverse outcome, while the AVM deep venous drainage is a risk factor only for temporary neurological deterioration.
BACKGROUND AND OBJECTIVE: Sylvian fissure arteriovenous malformations (AVMs) are among the most challenging AVMs to manage surgically. The estimates of their risk factors and prediction of their long-term prognosis are crucial for clinical decision-making. The authors conducted a retrospective review to patients with sylvian AVMs treated microsurgically to evaluate the risk factors associated with long-term prognosis. METHODS: Forty-one patients with sylvian fissure AVMs treated microsurgically between June 2009 and December 2011 were retrospectively reviewed with a mean follow-up time of 23 months (range 6-35 months). Chi-square test was utilized to compare proportions and rank-sum test to compare ordinal materials. Odds ratios (ORs) were used to assess risk factors associated with postoperative short-term outcome and long-term adverse outcome (mRS scores 3-6). RESULTS: One patient died in 1 month after surgery. Eighteen (43.9%) patients had postoperative transient neurological deterioration. Good outcomes (mRS scores 0-2) were observed in 29 (72.5%) patients in the follow-up. From the multiple logistic regression, a history of AVM bleeding and deep venous drainage increase the risk of postoperative transient neurological deterioration, with OR = 8.211 and OR = 4.869, respectively. A history of AVM bleeding was a risk factor for long-term adverse outcome, with OR = 7. CONCLUSIONS: Despite different Sugita classification subtypes, sylvian fissure AVMs' long-term results with microsurgical resection are better than expected; a history of AVM bleeding is a risk factor for postoperative temporary neurological deterioration and for long-term adverse outcome, while the AVM deep venous drainage is a risk factor only for temporary neurological deterioration.
Authors: H Mast; W L Young; H C Koennecke; R R Sciacca; A Osipov; J Pile-Spellman; L Hacein-Bey; H Duong; B M Stein; J P Mohr Journal: Lancet Date: 1997-10-11 Impact factor: 79.321
Authors: Michael T Lawton; Rose Du; Mary Nelson Tran; Achal S Achrol; Charles E McCulloch; S Claiborne Johnston; Nancy J Quinnine; William L Young Journal: Neurosurgery Date: 2005-03 Impact factor: 4.654
Authors: D H Duong; W L Young; M C Vang; R R Sciacca; H Mast; H C Koennecke; A Hartmann; S Joshi; J P Mohr; J Pile-Spellman Journal: Stroke Date: 1998-06 Impact factor: 7.914
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