title: Sylvian fissure arteriovenous malformations: long-term prognosis and risk factors.
abstract: OBJECTIVE
  Sylvian fissure arteriovenous malformations (AVMs) are among the most challenging AVMs to manage surgically. The estimates of their risk factors and prediction of their long-term prognosis are crucial for clinical decision-making. The authors conducted a retrospective review to patients with sylvian AVMs treated microsurgically to evaluate the risk factors associated with long-term prognosis.
  
  
  METHODS
  Forty-one patients with sylvian fissure AVMs treated microsurgically between June 2009 and December 2011 were retrospectively reviewed with a mean follow-up time of 23 months (range 6-35 months). Chi-square test was utilized to compare proportions and rank-sum test to compare ordinal materials. Odds ratios (ORs) were used to assess risk factors associated with postoperative short-term outcome and long-term adverse outcome (mRS scores 3-6).
  
  
  RESULTS
  One patient died in 1 month after surgery. Eighteen (43.9%) patients had postoperative transient neurological deterioration. Good outcomes (mRS scores 0-2) were observed in 29 (72.5%) patients in the follow-up. From the multiple logistic regression, a history of AVM bleeding and deep venous drainage increase the risk of postoperative transient neurological deterioration, with OR = 8.211 and OR = 4.869, respectively. A history of AVM bleeding was a risk factor for long-term adverse outcome, with OR = 7.
  
  
  CONCLUSIONS
  Despite different Sugita classification subtypes, sylvian fissure AVMs' long-term results with microsurgical resection are better than expected; a history of AVM bleeding is a risk factor for postoperative temporary neurological deterioration and for long-term adverse outcome, while the AVM deep venous drainage is a risk factor only for temporary neurological deterioration.
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen District, Beijing, 100050, China, liulingtong21@yahoo.com.cn.
authors: Lingtong
authors: L
authors: Liu
authors: Hao
authors: H
authors: Li
authors: Jian
authors: J
authors: Zheng
authors: Shuo
authors: S
authors: Wang
authors: Jizong
authors: J
authors: Zhao
authors: Yong
authors: Y
authors: Cao
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000601:surgery; D002648:Child; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000473:pathology / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D007431:Intraoperative Complications / Q000453:epidemiology; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
references: Neurosurgery. 1987 Jul;21(1):7-14
references: 3614608
references: Lancet. 2009 May 9;373(9675):1632-44
references: 19427958
references: Neurosurgery. 2007 Jul;61(1):29-36; discussion 36-8
references: 17621016
references: Stroke. 2003 May;34(5):e29-33
references: 12690217
references: J Neurosurg. 2001 Oct;95(4):633-7
references: 11596958
references: Stroke. 2002 Dec;33(12):2794-800
references: 12468772
references: Stroke. 1998 Jun;29(6):1167-76
references: 9626290
references: Stroke. 1996 Jan;27(1):1-6
references: 8553382
references: Neurosurgery. 2005 Mar;56(3):485-93; discussion 485-93
references: 15730573
references: Stroke. 1988 May;19(5):604-7
references: 3363593
references: Lancet. 1997 Oct 11;350(9084):1065-8
references: 10213548
references: Zentralbl Neurochir. 2006 May;67(2):81-7
references: 16673240
references: J Neurosurg. 2000 Jan;92(1):39-44
references: 10616080
references: Neurosurg Clin N Am. 2012 Jan;23(1):1-6
references: 22107853
references: Neurology. 1996 Apr;46(4):949-52
references: 8780070
references: Zhonghua Yi Xue Za Zhi. 2011 Jun 21;91(23):1609-12
references: 21914393