A Grading System Research Based On Endovascular Embolization Therapy For Brain Arteriovenous Malformations

Objective:Brain arteriovenous malformations is the result of abnormal development of intracranial vessels.Surgical intervention is the most effective method for symptomatic bAVM.At present,Surgical treatment of bAVM includes surgical resection,endovascular embolization,stereotactic radiosurgery.Each treatment method has its advantages and disadvantages.Spetzler-Martin(S-M)grading system is a widely used preoperative evaluation system,but its original purpose is to evaluate the surgical risk and prognosis of the surgical resection of arteriovenous malformations,and its value in guiding the selection of cases of interventional embolization and stereotactic radiotherapy is limited.In this study,we analysis the imaging characteristics of patients with endovascular embolization therapy in our hospital and the correlation analysis with prognosis,we attempted to establish a grading system for endovascular embolization therapy,to guide the selection of endovascular embolization targets and prognosis evaluation for arteriovenous malformations。Methods:We performed a retrospective review of 72 patients with bAVM treated at our institution from January 2017 to December 2020.Collect and organize the general clinical data of patients,including:gender,age,primary discomfort,Nidus’ location,size,shape,diffuse nidus,the number and diameter of feeding artery,relations of main of feeding artery with malformations nidus,number of venous drainage,deep venous drainage,bleeding,number of treatment,CT/MR/DS A data and embolic material.The correlation between the above data and the surgical outcome and complications was analyzed.Meanwhile,the variables involved in S-M and AVMES grading system were collected,and the accuracy of the grading model established in this study was compared with the two grading systems.Result:Among the 72 conformed to the standard patients,the proportion of male and female was 50.0%(36/72).The age range ranged from 12 to 64 years,with a mean of 33.1±13.7 years.62.5%(45/72)of the patients were first diagnosed as bleeding,18.1%(13/72)as epileptic seizure,12.5%(9/72)as headache,and 6.9%(5/72)as recurrent dizziness.Finally,we build a new grading system of transcatheter embolization(TEGS).it contains five evaluation variables,the nidus’ diameter,the relationship between feeding artery and nidus,the number of feeding arterial,diameter of feeding artery.Receiver-operator curve analysis showed that this grading system was robust in its discriminative ability,with an area under the curve(AUC)=0.820(vs S-M:0.667;AVMES:0.807)for complete obliteration,with correlation analysis:P<0.001(vs S-M:0.023;AVMES:<0.001),and AUC=0.586(vs S-M:0.563,AVMES:0.577),P=0.329>0.05(vs S-M:0.475;AVMES:0.376)for functional complication.and 0.706(vs S-M:0.648;AVMES:0.685),P=0.071>0.05(vs S-M:0.227;AVMES:0.147)for permanent complication,Although there was no significant correlation with the occurrence of surgical complications,it was looks better than S-M and AVMES classification.Conclusion:TEGS can be used as a preoperative evaluation for endovascular embolization of bAVM to guide the selection of surgical strategies.