| Objective:To explore the correlation between the clinical characters,lesion’s location and morphology,characters of vascular architecture and risk of essencial hemorrahage in patient with brain arteriovenous malformation,and further analyze the influential factors to it’s prognosis,we collected 323 cases with their clinical and image data and made a retrospective analysis.Methods:The patients with brain arteriovenous malformation who met the inclusion criteria from January 2014 to December 2021 in tthe Department of Neurosurgery of the Affiliated Hospital of Guizhou Medical University were retrospectively reviewed.The His medical record system was used to collect clinical characteristics,including gender,age,first symptom,smoking history,underlying medical history,family history of cerebrovascular disease,and history of previous hemorrhage;DSA was used to analyze the lesion characteristics and vascular architecture characteristics of brain arteriovenous malformations,including lesions Size,location,scope of involvement,supplying arteries(number,type),draining veins(number,type,combined with dilation),other abnormal intracranial vascular diseases(intracranial aneurysm,arteriovenous fistula).They were divided into hemorrhage group and non-hemorrhage group according to the results of brain CT diagnosis.After clinical surgical intervention or conservative treatment,they were divided into a good prognosis group and a poor prognosis group according to the modified Rankin scale score at the 3-month follow-up after discharge.SPSS 25.0 software was used to statistically analyze the factors that cause b AVM rupture hemorrhage and prognostic factors.Graph Pad prism 8.0 software was used to draw data map and ROC curve to compare the relationship between variables,and R language 4.1 software was used to draw heat map to show the cause of High risk factors for rupture hemorrhage,Nomogram plots and calibration curves were drawn to verify the validity of high risk factors for hemorrhage.Results:A total of 323 patients with b AVM were included during the study period,with an average age of 31.48 ± 14.89 years.There were 210 males(65.02%)and 113females(34.98%).(1)According to the diagnosis results of cranial CT,there were 139 patients(43.03%)with hemorrhage and 184 patients(56.97%)with non-hemorrhage.The results of univariate analysis showed that they had diabetes,essential hypertension and familial cerebrovascular disease.,b AVM location,number of feeding arteries,intracranial aneurysm,number of draining veins,type of draining veins and dilatation of draining veins were associated with b AVM rupture and hemorrhage(P<0.05).Included in multivariate Logistic regression analysis showed that the first symptoms were disturbance of consciousness(OR= 125.734),functional area disturbance(OR=29.236)and intracranial hypertension(OR= 10.573),and family history of cerebrovascular disease(OR= 4.712),Lesions with single draining vein(OR=14.279),dilated draining vein(OR= 3.670),deep supratentorial(OR= 2.850),double draining vein(OR= 2.827),deep vein drainage(OR= 2.353)were Independent risk factors for b AVM hemorrhage.(2)According to the results of m RS score during follow-up,there were 263patients(81.42%)with good prognosis and 60 patients(18.58%)with poor prognosis.Univariate analysis showed: whether b AVM hemorrhage,b AVM location,number of blood supplying arteries,The number of draining veins,whether combined with draining vein dilatation,the type of draining veins,and different treatment methods were related to the prognosis of patients(P< 0.05).Multivariate Logistic regression analysis showed that b AVM hemorrhage(OR= 31.941),deep lesions(OR= 7.972),posterior fossa lesions(OR= 6.834),were independent risk factors for poor prognosis of b AVM patients 3 months after discharge.Compared with endovascular intervention alone,combined with Gamma Knife radiotherapy(OR= 0.078)was a protective factor for better prognosis 3 months after discharge in patients with b AVM.Conclusions:(1)1.The number of draining veins is less than 3,deep venous drainage and dilation of the draining veins are the main factors leading to hemorrhage in the vascular architecture of b AVM;2.The b AVM located in the deep supratentorial is also a high risk factor for hemorrhage;3.The first symptoms are: b AVM patients with disturbance of consciousness,functional area disturbance and intracranial hypertension symptoms and family history of cerebrovascular disease should be alert to the high risk of hemorrhage;(2)1.b AVM hemorrhage,lesions located in deep supratentorial and posterior cranial fossa are followed up 3 months after discharge High risk factors for poor prognosis;2.Compared with endovascular intervention alone,combined with Gamma Knife radiotherapy can improve the clinical prognosis of patients with b AVM at3-month follow-up after discharge. |
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