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A Tractography-Based Grading Scale of Brain Arteriovenous Malformations Close to the Corticospinal Tract to Predict Motor Outcome After Surgery

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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
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关键词: arteriovenous malformation corticospinal tract patient selection surgery tractography

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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.

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出版当年[2018]版:
大类 | 2 区 医学
小类 | 3 区 临床神经病学 3 区 神经科学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 临床神经病学 3 区 神经科学
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出版当年[2017]版:
Q2 NEUROSCIENCES Q2 CLINICAL NEUROLOGY
最新[2023]版:
Q2 CLINICAL NEUROLOGY Q3 NEUROSCIENCES

影响因子: 最新[2023版] 最新五年平均 出版当年[2017版] 出版当年五年平均 出版前一年[2016版] 出版后一年[2018版]

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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
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