British journal of neurosurgery · 2021
The influence of hemorrhage presentation on clinical outcomes of curative embolisation in 125 cerebellar arteriovenous malformations.
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Liu Dong, Zhang Shuai, Ma Xiaowei, Li Zhongjun, Ge Huijian, Wang Yilong, Lv Ming
Аннотация
BACKGROUND: This study investigated the influence of periprocedural hemorrhage and clinical outcomes with an endovascular therapeutic strategy for cerebellar arteriovenous malformations (cAVMs).
METHODS: From December 2006 to January 2018, 125 cAVMs were classified as types I-IV and received endovascular embolization via Onyx or Glubran 2. The risk factors of hemorrhage were analyzed using univariate and multivariate logistic analyses. A modified Rankin Scale (mRS) score was used to evaluate the neurological function before and 1 year after the operation. Results Of 125 patients, 63 had type I cAVMs, 2 type II cAVMs, 48 type III cAVMs, and 12 type IV cAVMs. A total of 88 (70.4%) patients had clinical manifestations of intracranial hemorrhage. Multivariate logistic regression analysis showed that age (OR, 2.276; 95% CI, 1.132 - 5.663), flow-related aneurysm (OR, 2.845; 95% CI, 1.265 - 6.248), lesion size (OR, 3.005; 95% CI, 1.119 - 5.936), and the number of feeding arteries (OR, 0.105; 95% CI, 0.081 - 0.312) were still the significant independent risk factors of intracranial hemorrhage. During a 1-year follow-up, 109 patients (87.2%) had good outcomes (mRS 0 - 2), 12 patients (9.6%) had poor outcomes (mRS 3 - 4), 4 patients (3.2%) died, and 3 patients had intracranial hemorrhage due to the incomplete embolization of cAVMs.
CONCLUSIONS: Endovascular embolization is a feasible treatment for cAVMs. Age, flow-related aneurysm, lesion size, and the number of feeding arteries are the significant risk factors of periprocedural hemorrhage. Moreover, the lesion characteristics must be given full consideration when using Onyx or Glubran 2 before cAVMs embolization.
METHODS: From December 2006 to January 2018, 125 cAVMs were classified as types I-IV and received endovascular embolization via Onyx or Glubran 2. The risk factors of hemorrhage were analyzed using univariate and multivariate logistic analyses. A modified Rankin Scale (mRS) score was used to evaluate the neurological function before and 1 year after the operation. Results Of 125 patients, 63 had type I cAVMs, 2 type II cAVMs, 48 type III cAVMs, and 12 type IV cAVMs. A total of 88 (70.4%) patients had clinical manifestations of intracranial hemorrhage. Multivariate logistic regression analysis showed that age (OR, 2.276; 95% CI, 1.132 - 5.663), flow-related aneurysm (OR, 2.845; 95% CI, 1.265 - 6.248), lesion size (OR, 3.005; 95% CI, 1.119 - 5.936), and the number of feeding arteries (OR, 0.105; 95% CI, 0.081 - 0.312) were still the significant independent risk factors of intracranial hemorrhage. During a 1-year follow-up, 109 patients (87.2%) had good outcomes (mRS 0 - 2), 12 patients (9.6%) had poor outcomes (mRS 3 - 4), 4 patients (3.2%) died, and 3 patients had intracranial hemorrhage due to the incomplete embolization of cAVMs.
CONCLUSIONS: Endovascular embolization is a feasible treatment for cAVMs. Age, flow-related aneurysm, lesion size, and the number of feeding arteries are the significant risk factors of periprocedural hemorrhage. Moreover, the lesion characteristics must be given full consideration when using Onyx or Glubran 2 before cAVMs embolization.