机构:[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China重点科室诊疗科室神经外科神经外科首都医科大学附属天坛医院[2]China National Clinical Research Center for Neurological Diseases, Beijing, China[3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China[4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
Background: Surgical decision-making for brain arteriovenous malformations (AVMs) close to the corticospinal tract (CST) is always challenging. The purpose of this study was to develop a tractography-based grading scale to improve preoperative risk prediction and patient selection. Methods: We analyzed a consecutive, surgically treated series of 90 patients with AVMs within a 10-mm range from the CST demonstrated by preoperative diffusion tensor tractography. Poor motor outcome was defined as persistent postoperative limb weakness. We examined the predictive ability of nidus-to-CST distance (NCD), the closest CST level (CCL), deep perforating artery supply, as well as variables of the supplemented Spetzler-Martin grading system. Three logistic models were derived from different multivariable logistic regression analyses, of which the most predictive model was selected to construct a prediction grading scale. Receiver operating characteristic analysis was conducted to test the predictive accuracy of the grading scale. Results: Twenty-one (23.3%) patients experienced persistent postoperative limb weakness after a mean 2.7-year follow-up. The most predictive logistic model showed NCD (P = 0.001), CCL (P = 0.017), patient age (P = 0.004), and AVM diffuseness (P = 0.021) were independent predictors for poor motor outcome. We constructed the CLAD grading scale incorporating these predictors. The predictive accuracy of the CLAD grade was better compared with the supplemented Spetzler-Martin grade (area under curve = 0.84 vs. 0.68, P = 0.023). Conclusions: Both NCD and CCL predict motor outcome after resection of AVMs close to the CST. We propose the CLAD grading scale as an effective risk-prediction tool in surgical decision-making.
基金:
National Key Research and Development Program of China [2016YFC1301801]; Key Project of Beijing Municipal Commission of Science and Technology [D161100003816006]
第一作者机构:[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[2]China National Clinical Research Center for Neurological Diseases, Beijing, China[3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China[4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
通讯作者:
通讯机构:[1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[2]China National Clinical Research Center for Neurological Diseases, Beijing, China[3]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China[4]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
推荐引用方式(GB/T 7714):
Li Maogui,Jiang Pengjun,Guo Rui,et al.A Tractography-Based Grading Scale of Brain Arteriovenous Malformations Close to the Corticospinal Tract to Predict Motor Outcome After Surgery[J].FRONTIERS IN NEUROLOGY.2019,10(JUL):-.doi:10.3389/fneur.2019.00761.
APA:
Li, Maogui,Jiang, Pengjun,Guo, Rui,Liu, Qingyuan,Yang, Shuzhe...&Wang, Shuo.(2019).A Tractography-Based Grading Scale of Brain Arteriovenous Malformations Close to the Corticospinal Tract to Predict Motor Outcome After Surgery.FRONTIERS IN NEUROLOGY,10,(JUL)
MLA:
Li, Maogui,et al."A Tractography-Based Grading Scale of Brain Arteriovenous Malformations Close to the Corticospinal Tract to Predict Motor Outcome After Surgery".FRONTIERS IN NEUROLOGY 10..JUL(2019):-