Determinants of Staged Endovascular and Surgical Treatment Outcome of Brain Arteriovenous Malformations
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- Andreas Hartmann
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- Henning Mast
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- Jay P. Mohr
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- John Pile-Spellman
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- E. Sander Connolly
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- Robert R. Sciacca
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- Alexander Khaw
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
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- Christian Stapf
- From the Doris and Stanley Tananbaum Stroke Center (A.H., H.M., A.K., C.S., J.P.M.), Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY; the Stroke Unit, Department of Neurology (A.H.), Charité-Campus Benjamin Franklin, Berlin, Germany; Schlaganfallzentrum Halle (H.M.), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany; the Departments of Interventional Neuroradiology (J.P.-S.), Neurological Surgery (E.S.C.), and Medicine (R.R.S.), Columbia...
説明
<jats:p> <jats:bold> <jats:italic>Background and Purpose—</jats:italic> </jats:bold> Therapy of brain arteriovenous malformations (AVMs) often requires the combination of different treatment modalities. Independently assessed data on neurologic outcome after multidisciplinary AVM therapy are scarce. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods—</jats:italic> </jats:bold> The 119 consecutive patients (49% women, mean age 34±13 years) with brain AVMs receiving endovascular embolization followed by surgical treatment were analyzed. Neurologic impairment was assessed prospectively by a neurologist using the modified Rankin Scale (mRS) before, during, and after completed AVM therapy. The association of demographic, clinical, and morphologic characteristics with new treatment-related neurologic deficits was calculated. </jats:p> <jats:p> <jats:bold> <jats:italic>Results—</jats:italic> </jats:bold> The 119 patients were treated with 240 superselective embolizations (median, 2; range, 1 to 8) using n-butyl cyanoacrylate. Mean follow-up time after surgery was 9.6±13.2 months. On the Spetzler-Martin scale, 8% of the AVMs were grade 1, 27% grade 2, 40% grade 3, 22% grade 4, and 3% grade 5. Disabling treatment-related complications (mRS≥3) occurred in 5% (95% confidence interval [CI], 1% to 9%) of the patients. Nondisabling new deficits were observed in another 42% (95% CI, 33% to 51%). No patient died. Nonhemorrhagic AVM presentation (odds ratio [OR], 5.00; 95% CI, 1.75 to 14.29), deep venous drainage (OR, 3.09; 95% CI, 1.43 to 6.64), AVM location in an eloquent brain region (OR, 2.42; 95% CI, 1.10 to 5.33), and large AVM size (OR, 1.05; 95% CI, 1.01 to 1.09) were independently associated with new treatment-related deficits. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Our results suggest an increased treatment risk for patients with previously unbled AVMs from combined endovascular and surgical AVM therapy. Additional risk factors for treatment-related neurologic deficits may be large AVM size, deep venous drainage, and AVM location in eloquent brain regions. </jats:p>
収録刊行物
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- Stroke
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Stroke 36 (11), 2431-2435, 2005-11
Ovid Technologies (Wolters Kluwer Health)