Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs.This study aimed to investigate the learning curve and embolisation str...Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs.This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations(MATCH)registry in China,conducted between August 2011 and December 2023.A total of 213 complex AVMs were divided into two groups.Group 1 included the first 25 patients.The 188 cases in group 2 included patients numbered 26-213.A case-crossover design was employed to evaluate the influence of complications,unfavourable outcomes and worsening modified Rankin Scale(mRS)score.Cumulative summation analysis was performed to assess the learning curve.Results The rate of major complications decreased from 52.00%in group 1 to 34.57%in group 2(p=0.089),while the rate of unfavourable outcomes decreased from 44.00%in group 1 to 18.62%in group 2(p=0.004).The distribution of the three preoperative embolisation strategies was as follows:curative:72.00%and 19.15%,palliative:24.00%and 67.55%,and targeted:4.00%and 13.30%,respectively(p<0.001).Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes(p=0.022,OR=0.333).The mean follow-up duration was 49.90±20.54 months.The follow-up mRS score of 5-6 decreased from 9.09%in group 1 to 0.8%in group 2(p=0.035).Conclusions Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility.Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures.Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.展开更多
Introduction Hereditary hemorrhagic telangiectasia(HHT),also known as Osler-Weber-Rendu syndrome,is an autosomal dominant disease that can frequently be complicated by the presence of significant arteriovenous malform...Introduction Hereditary hemorrhagic telangiectasia(HHT),also known as Osler-Weber-Rendu syndrome,is an autosomal dominant disease that can frequently be complicated by the presence of significant arteriovenous malformations(AVMs)in the brain,lungs,gastrointestinal tract,and liver[1].The most prevalent hemorrhagic complications in patients with HHT include epistaxis,gastrointestinal hemorrhage,and anemia due to chronic blood loss[2].This case involved an unusual gastric prominence that was initially diagnosed as a gastrointestinal stromal tumor(GIST);however,further investigations culminated in a diagnosis of HHT.The endoscopic appearance of this type of gastric prominence has not been previously reported in cases of HHT,providing a fresh perspective on the endoscopic manifestations of the disease.展开更多
Background: Occipital arteriovenous malformations (AVMs) are still one of neurosurgery's most intriguing and challenging pathologies.In this study, we reviewed our series of patients with occipital AVMs admitted i...Background: Occipital arteriovenous malformations (AVMs) are still one of neurosurgery's most intriguing and challenging pathologies.In this study, we reviewed our series of patients with occipital AVMs admitted in Beijing Tiantan Hospital from June 2013 through January 2015 and attempted to evaluate the risk factors of visual field deficits (VFDs) in these patients at presentation.Methods: Forty-two consecutive patients with occipital AVMs were included in our study.Patient parameters (age, sex, and history of hemorrhage) and AVM characteristics (size, side, venous drainage, Spetzler-Martin grade, and diffuseness) were collected.VFDs were quantified using an Octopus perimetry.Conventional MRI,blood oxygen level dependent fMRI (BOLD-fMRI) of the visual cortex, and diffusion tensor imaging (DTI) of the optic radiation were performed.The least distances from the AVM to the optic radiation (AVM-OR) and from the AVM to the visual cortex (AVM-VC) were measured.Univariate analyses were used to correlate initial VFDs with patient parameters, AVM characteristics, AVM-OR, and AVM-VC distances.Results: VFDs were identified in 14 patients, among which 12 patients presented with a history of hemorrhage and 2 patients presented with nonhemorrhagic chronic headache.VFDs were more common (P =0.000003) in patients with ruptured AVMs.VFD frequency was not associated with patient age, sex, and AVM characteristics (size, side,venous drainage, S-M grade, and diffuseness).Unlike other lesions involving the optic radiation and visual cortex, the frequency of VFDs in occipital AVMs did not correlate with the AVM-OR and AVM-VC distances (P =0.640 and 0.638,respectively).Conclusions: A history of hemorrhage is an independent risk factor of VFDs in occipital AVMs.Most unruptured occipital AVMs may present with chronic headache and seizures other than VFDs.The distances from the AVMs to the optic radiation and the visual cortex are not associated with preexisting VFDs.Our results prompt us to probe into the plasticity of the visual pathway in patients with this congenital vascular anomaly.展开更多
基金supported by the National Key Research and Development Program of China(Grant No.2021YFC2501101 and 2020YFC2004701 to XC)Natural Science Foundation of China(Grant no.82202244 to YC)Top Talent Support Program for Medical Experts Team of Wuxi Health Committee(Grant No.202109 to SW).
文摘Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs.This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations(MATCH)registry in China,conducted between August 2011 and December 2023.A total of 213 complex AVMs were divided into two groups.Group 1 included the first 25 patients.The 188 cases in group 2 included patients numbered 26-213.A case-crossover design was employed to evaluate the influence of complications,unfavourable outcomes and worsening modified Rankin Scale(mRS)score.Cumulative summation analysis was performed to assess the learning curve.Results The rate of major complications decreased from 52.00%in group 1 to 34.57%in group 2(p=0.089),while the rate of unfavourable outcomes decreased from 44.00%in group 1 to 18.62%in group 2(p=0.004).The distribution of the three preoperative embolisation strategies was as follows:curative:72.00%and 19.15%,palliative:24.00%and 67.55%,and targeted:4.00%and 13.30%,respectively(p<0.001).Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes(p=0.022,OR=0.333).The mean follow-up duration was 49.90±20.54 months.The follow-up mRS score of 5-6 decreased from 9.09%in group 1 to 0.8%in group 2(p=0.035).Conclusions Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility.Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures.Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.
基金supported by the Guangxi Natural Science Foundation Project[grant number 2024GXNSFBA010279].
文摘Introduction Hereditary hemorrhagic telangiectasia(HHT),also known as Osler-Weber-Rendu syndrome,is an autosomal dominant disease that can frequently be complicated by the presence of significant arteriovenous malformations(AVMs)in the brain,lungs,gastrointestinal tract,and liver[1].The most prevalent hemorrhagic complications in patients with HHT include epistaxis,gastrointestinal hemorrhage,and anemia due to chronic blood loss[2].This case involved an unusual gastric prominence that was initially diagnosed as a gastrointestinal stromal tumor(GIST);however,further investigations culminated in a diagnosis of HHT.The endoscopic appearance of this type of gastric prominence has not been previously reported in cases of HHT,providing a fresh perspective on the endoscopic manifestations of the disease.
文摘Background: Occipital arteriovenous malformations (AVMs) are still one of neurosurgery's most intriguing and challenging pathologies.In this study, we reviewed our series of patients with occipital AVMs admitted in Beijing Tiantan Hospital from June 2013 through January 2015 and attempted to evaluate the risk factors of visual field deficits (VFDs) in these patients at presentation.Methods: Forty-two consecutive patients with occipital AVMs were included in our study.Patient parameters (age, sex, and history of hemorrhage) and AVM characteristics (size, side, venous drainage, Spetzler-Martin grade, and diffuseness) were collected.VFDs were quantified using an Octopus perimetry.Conventional MRI,blood oxygen level dependent fMRI (BOLD-fMRI) of the visual cortex, and diffusion tensor imaging (DTI) of the optic radiation were performed.The least distances from the AVM to the optic radiation (AVM-OR) and from the AVM to the visual cortex (AVM-VC) were measured.Univariate analyses were used to correlate initial VFDs with patient parameters, AVM characteristics, AVM-OR, and AVM-VC distances.Results: VFDs were identified in 14 patients, among which 12 patients presented with a history of hemorrhage and 2 patients presented with nonhemorrhagic chronic headache.VFDs were more common (P =0.000003) in patients with ruptured AVMs.VFD frequency was not associated with patient age, sex, and AVM characteristics (size, side,venous drainage, S-M grade, and diffuseness).Unlike other lesions involving the optic radiation and visual cortex, the frequency of VFDs in occipital AVMs did not correlate with the AVM-OR and AVM-VC distances (P =0.640 and 0.638,respectively).Conclusions: A history of hemorrhage is an independent risk factor of VFDs in occipital AVMs.Most unruptured occipital AVMs may present with chronic headache and seizures other than VFDs.The distances from the AVMs to the optic radiation and the visual cortex are not associated with preexisting VFDs.Our results prompt us to probe into the plasticity of the visual pathway in patients with this congenital vascular anomaly.
