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Characteristics of deep arteriovenous malformations:contrast with superficial arteriovenous malformationsObjective: To explore the difference between deep arteriovenous malformations(dAVM)and superficial arteriovenous malformations(s AVM)conserning natural history,clinical features and angioarchitecture characteristics.Methods : Eighty patients with dAVMs and 499 patients with s AVMs from January 2006 to December 2016 were retrospectively reviewed.Clinical and imaging features were collected and compared between the two groups with dAVM or s AVM.Results:(1)The annual bleeding rate of the dAVM patients was 4.17%,and the annual rebleeding rate was 73.6%,which was higher than that of s AVM patients(1.93%,9.3% respectively).Kaplan-Meier survival analysis has found that dAVM patients tend to present with hemorrhage earlier(log-rank,P = 0.006).(2)Compared with patients with s AVM,patients with dAVM were younger(22 [15,30.75] vs 30 [21,45],P<0.001),with bleeding as the first presentation(82.5% vs 59.5%)),and a lower probability of epilepsy(1.3% vs 15.8%)as well as headache(3.75% vs 14.3%);ICH+IVH happened most common in dAVM patients(42.4% vs 18.0%),followed by ICH(28.8% vs 54.3%))and IVH(27.3% vs 15.7%)while SAH was the least common hemorrhagic presentation(1.2% vs 12%);and more patients had m RS score of 3-5(23.8% vs 12.2%,P=0.006).(3)Compared with the group with s AVM,there were more SMG IV-V patients in the group with dAVM(50.0% vs 14.0%;P<0.001),with more diffused lesions(66.3% vs 47.2%;P=0.002),and more deep perforating artery feeding lesions(87.5% vs 6.0%;P<0.001).There were also more BG 4-5 patients(76.3% VS 34.7%;P<0.001)in the dAVM patients,with more lesion fed by over 5 feeding arteries(62.5% VS 40%;P = 0.001),the maximum diameter of the which was more offten below1 mm(63.8% vs 31.8%;P<0.001),Deep venous drainage(68.8% VS 18%;P < 0.001),and single deep venous drainage(56.3% vs 16%;P<0.001)more commonly occurred in dAVM patients.Conclusion:dAVM patients was more likely to present with hemorrhage,with higher risks of bleeding and rebleeding.The risk of neurological complications after bleeding and rebleeding was higher.Deep perforating arteries were usually involved in blood supply.The number of feeding arteries was larger and the lesion was often diffused.The characteristics mentioned above all determine that the structure of dAVM is more complicated and challenging in treatment.dAVMs often dained by deep venous system,which is highly correlated with the risk of dAVM bleeding.Part ? Risk factors for rupture of deep arteriovenous malformationsObjective: To explore the risk factors associated with hemorrhage in the patients with deep arteriovenous malformations(dAVM).Methods: Eighty consecutive patients,addmitted by Changhai Hospital druing the period from January 2006 to December 2016,with dAVMs were enrolled retrospectively.On the basis of whether they presented with hemorrhage,they were divided into rupture group and non-rupture group.The clinical data and angioarchitectural characteristics of the dAVMs were analyzed using Univariate and multivariate logistic analysis.Kaplan-Meier analyses was used to demonstrat the the rupture rate in each factor.Results: Univariate analysis revealed that female gender(P=0.024),younger age(P=0.047),lesions fed by Ach A(P=0.037)and with intranidal aneurysms(P=0.019)were related to rupture of dAVMs.The Logistics regression analysis demonstrated that female gender(OR=6.9,95% CI:1.2-36.7,P=0.025),lesions fed by ACh A(OR=4.4,95% CI:1.1-17.6,P=0.035)and with intranidal aneurysms(OR=6.1,95% CI:1.2-31.9,P=0.033)were the independent risk factors for rupture.Kaplan-Meier analysis and log-rank tests indicated that female patients(log-rank?2=5.208,P=0.022),dAVMs fed by ACh A(Log Rank?2=7.554,P=0.006)and along with intranidal aneurysms(Log Rank?2=6.085,P=0.014)tend to present with hemorrhage earlier.Conclusion: Female gender,lesions fed by Ach A and with intranidal aneurysms are independent risk factors for rupture of dAVMs,and these lesions may tend to present with hemorrhage earlier.Part ? Combined Treatment with Endovascular Embolization and Gamma Knife Surgery of Deep Arteriovenous Malformations: a single center experienceObjective: To investigate the safety and efficacy of embolization combined with gamma knife in the treatment(EVT+GKS)of deep arteriovenous malformations(dAVM),and find the factors related to cure and rebleeding after treatment.Methods: Patients with dAVM who underwent EVT+GKS in our center from January 2006 to December 2016 were retrospectively reviewed.The clinical data,angioarchitectural characteristics,EVT data,GKS data and follow-up data of the AVMs were analyzed using Univariate.Results:27 patients underwent EVT+GKS,during follow-up(mean 36.4months)9 patients(33.3%)was totally occlusion,4 patients(14.8%)rebleeding after treatment,annual rebleeding rate was 4.88%,26 patients(96.3%)had a m RS scole of 0-2,2 patients were worsen clinical outcome because of rebleeding.Univariate analysis revealed that diameter <3cm(P=0.004),SMG ?III(P=0.013),compact distribution(P=0.011),number of feeding artery <5(P=0.001),BG<4(P=0.030),single vein drainage(P=0.003),single deep vein drainage(P=0.003),reduce of the AVM ? 50%(P=0.013),residual compact distribution(P=0.004),non-dangerous structure of bleeding(P=0.026)before GKS,the central dose ?31Gy,and GKS dose curve >52% were related to completely occlusion.The factors related to rebleeding after treatment were bigger AVM(P=0.039),dangerous structure of bleeding before GKS(P=0.004).Conclusion:In the treatment of dAVM,EVT+GKS could achieve a satisfactory complete occlusion rate and favorable outcome without increasing the risk of bleeding.dAVMs with diameter <3cm,SM grade ?III,and a simple structure is more easily cured.It is suggested that: priority should be given to embolize the dangerous structure of bleeding;minimize the volume of deformed masses;the distribution of lesions is compact can help improve the rate of occlusion,reduce the central dose of gamma knife treatment. |
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