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Risk factors for neurological deficits after surgical treatment of brain arteriovenous malformations supplied by deep perforating arteries

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Abstract

The treatment of brain arteriovenous malformations supplied by deep perforating arteries (PA) (P-BAVM) remains challenging. The aims of this study were to determine the outcomes after surgical treatment in patients with P-BAVMs and to identify the risk factors associated with postoperative neurological deficits. We retrospectively reviewed the medical charts and imaging records of 228 consecutive patients with BAVMs who underwent microsurgical resection of their BAVMs at Beijing Tiantan Hospital between September 2012 and March 2016. Patients were included if the BAVMs were totally or partially supplied by PA. All patients had undergone preoperative diffusion tensor imaging (DTI), MRI, 3D time-of-flight MRA (3D TOF-MRA) and digital subtraction angiography (DSA) followed by resection. Both functional and angioarchitectural factors were analysed with respect to the postoperative neurological deficits, including motor deficits, visual field deficits and aphasia. Statistical analysis was performed using the statistical package SPSS (version 20.0.0, IBM Corp.). Fifty-nine patients with P-BAVMs were enrolled. Radical obliteration was achieved in all P-BAVMs according to postoperative DSA. Forty-five (76.3%) patients obtained neurological deficits 1 week after surgery. At a mean follow-up of 14.7 ± 9.4 (3–30) months after surgery, 34 patients (57.6%) had long-term neurological deficits. Multivariable logistic regression analyses showed that a shorter lesion-to-eloquent fibre tracts distance (LFD) was an independent risk factor for short- (P = 0.014) and long-term (P = 0.013) neurological deficits. The cut-off point of LFD for long-term neurological deficits was 5.20 mm. The predominant supply of the PA (P = 0.008) was an independent risk factor for long-term neurological deficits. This study identified a high risk of surgical morbidity for P-BAVMs. The predominant supply of the PA and a shorter LFD are crucial risk factors for postoperative neurological deficits in patients with P-BAVMs.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People’s Republic of China

    Yuming Jiao, Jun Wu, Hao Li, Xin Chen, Zhicen Li, Ji Ma, Yong Cao, Shuo Wang & Jizong Zhao

  2. China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China

    Yuming Jiao, Jun Wu, Hao Li, Xin Chen, Zhicen Li, Ji Ma, Yong Cao, Shuo Wang & Jizong Zhao

  3. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China

    Yuming Jiao, Jun Wu, Hao Li, Xin Chen, Zhicen Li, Ji Ma, Yong Cao, Shuo Wang & Jizong Zhao

  4. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People’s Republic of China

    Yuming Jiao, Jun Wu, Hao Li, Xin Chen, Zhicen Li, Ji Ma, Yong Cao, Shuo Wang & Jizong Zhao

  5. Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China

    Fuxin Lin

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  1. Yuming Jiao
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  2. Fuxin Lin
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  3. Jun Wu
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  4. Hao Li
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  5. Xin Chen
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  6. Zhicen Li
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  7. Ji Ma
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  8. Yong Cao
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  9. Shuo Wang
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  10. Jizong Zhao
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Corresponding author

Correspondence to Yong Cao.

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Funding

This study was supported by the “Key Project of Beijing Municipal Science & Technology Commission” (Grant No. D161100003816006, Principle Investigator: Professor Shuo Wang and Grant No. D161100003816005, Principle Investigator: Professor Jizong Zhao) and the “National key research and development program of China during the 13th Five-Year Plan Period” (Grant No. 2016YFC1301801, Principle Investigator: Professor Shuo Wang and Grant No. 2016YFC1301803, Principle Investigator: Professor Yong Cao).

Conflict of interest

The authors declare that they have are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of Beijing Tiantan Hospital Affiliated with Capital Medical University (ky2012-016-02) and the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants who were included in the study.

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Jiao, Y., Lin, F., Wu, J. et al. Risk factors for neurological deficits after surgical treatment of brain arteriovenous malformations supplied by deep perforating arteries. Neurosurg Rev 41, 255–265 (2018). https://doi.org/10.1007/s10143-017-0848-6

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  • DOI: https://doi.org/10.1007/s10143-017-0848-6

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