Arteriovenous Malformations of the Posterior Fossa: Focus on Surgically Treated Patients Presenting with Hemorrhage

Autor: Päivi Koroknay-Pál, Anni Pohjola, Elias Oulasvirta, Hanna Lehto, Ahmad Hafez, Aki Laakso
Přispěvatelé: HUS Neurocenter, Department of Neurosciences, Clinicum, Neurokirurgian yksikkö, University of Helsinki
Rok vydání: 2018
Předmět:
GRADING SCALE
Male
Infratentorial
3124 Neurology and psychiatry
Cohort Studies
0302 clinical medicine
Child
Stroke
RISK
Univariate analysis
Arteriovenous malformation
Middle Aged
3. Good health
Cerebellar hemorrhage
Natural history
Treatment Outcome
030220 oncology & carcinogenesis
Child
Preschool
Cohort
Arteriovenous Fistula
Female
medicine.symptom
Intracranial Hemorrhages
Adult
Intracranial Arteriovenous Malformations
medicine.medical_specialty
STEREOTACTIC RADIOSURGERY
Adolescent
CLINICAL ARTICLE
Lesion
03 medical and health sciences
Young Adult
Posterior fossa
medicine
Humans
Aged
Retrospective Studies
Intracerebral hemorrhage
business.industry
3112 Neurosciences
Infant
Newborn
Infant
Odds ratio
NATURAL-HISTORY
ADULTS
medicine.disease
3126 Surgery
anesthesiology
intensive care
radiology
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: World neurosurgery. 116
ISSN: 1878-8769
Popis: BACKGROUND: Arteriovenous malformations (AVMs) of the posterior fossa are demanding lesions that often present with rupture. Studies including outcome analyses in surgically operated patients with ruptured infratentorial AVMs are scarce. Certain anatomic and demographic features have shown associations with postoperative outcomes. METHODS: Eighty-six patients with infratentorial AVM were collected from our AVM database. Fifty-four patients were admitted from 1990 onward, and their demographic, lesion, and treatment characteristics were analyzed. The cohort was further refined to 38 consecutive patients with surgically treated ruptured infratentorial AVM admitted to our center between 1990 and 2014, and statistical analyses of factors influencing outcomes were conducted. RESULTS: Twenty-seven patients (69%) had a favorable outcome at early follow-up and 24 (67%) had a favorable outcome at final follow-up. Factors associated with poor outcome in early recovery on univariate analyses were deep venous drainage of the lesion (odds ratio (OR 5.3; P = 0.037) and high Hunt & Hess score (P = 0.003). In the multivariate model, independent predictors for poor outcome were deep venous drainage (OR, 14.5; P = 0.010) and older age at admission (OR, 1.06; P = 0.028). The sole independent predictor for poor outcome at last follow-up was deep venous drainage (OR, 5.00; P = 0.046). The total follow-up time was 370 person-years. CONCLUSIONS: AVMs of the posterior fossa usually present with rupture and thus require prompt clinical treatment. The majority of surgically treated patients recover favorably. Our data show that venous drainage patterns have the greatest influence on the patient's postoperative condition. Other influencing factors include the severity of hemorrhage and patient age at admission.
Databáze: OpenAIRE
Externí odkaz: