Microsurgical Outcome of Cerebellar Arteriovenous Malformations: Single-Center Experience

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• 作者：Xianzeng Tong¹ ; ² ; ³ ; ⁴ ; Jun Wu¹ ; ² ; ³ ; ⁴ ; Fuxin Lin¹ ; ² ; ³ ; ⁴ ; Yong Cao¹ ; ² ; ³ ; ⁴ ; ^{caoyong6@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Yuanli Zhao¹ ; ² ; ³ ; ⁴ ; Shuo Wang¹ ; ² ; ³ ; ⁴ ; ^{captain9858@vip.sina.com" class="auth_mail" title="E-mail the corresponding author} ; Jizong Zhao¹ ; ² ; ³ ; ⁴
• 关键词：Cerebellar arteriovenous malformations (AVMs) ; Microsurgery ; Treatment outcome
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：95
• 期：Complete
• 页码：469-479
• 全文大小：3939 K

文摘

We aimed to describe our single-center experience in treating cerebellar arteriovenous malformations (AVMs) with microsurgical resection.

Methods

During a 16-year period, 181 patients with cerebellar AVMs were surgically treated at the Department of Neurosurgery in Beijing Tiantan Hospital. Patient functional status was evaluated using modified Rankin Scale (mRS) scores both before treatment and at the last follow-up. The mRS scores at the last follow-up were dichotomized as good outcome (mRS <3) and poor outcome (mRS ≥3). The treatment modalities, post-treatment complications, obliteration rate, and follow-up outcomes were analyzed.

Results

Of the 181 patients, 172 (95%) patients presented with initial hemorrhage and 62 (34%) patients experienced rehemorrhage before microsurgical treatment. Complete obliteration of the AVMs was achieved in 177 (97.8%) patients. Good functional outcome was achieved in 144 (80%) of the patients. The surgical mortality rate was 4.4% (8/181), and overall mortality rate was 6.6% (12/181). Poor outcome was significantly associated with increasing age (P = 0.035; odds ratio [OR], 1.030; 95% CI 1.002–1.060), presurgical mRS ≥3 (P = 0.029; OR, 2.563; 95% CI 1.101–5.968), eloquent AVM location (P = 0.015; OR, 3.058; 95% CI 1.244–7.516), and presurgical rehemorrhage (P = 0.008; OR, 3.266; 95% CI 1.358–7.858).

Conclusion

Good outcome can be achieved by microsurgical resection in most patients with cerebellar AVMs. Increasing age at surgery, poor presurgical functional status, eloquent AVM location, and presurgical rehemorrhage are independent predictors of poor outcomes after AVM resection. We recommend early surgical resection for all surgically accessible cerebellar AVMs to prevent subsequent hemorrhage and resultant poor neurologic outcomes.