title: Risk factors for neurological deficits after surgical treatment of brain arteriovenous malformations supplied by deep perforating arteries.
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.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Yuming
authors.initials: Y
authors.lastname: Jiao
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
authors.forename: Fuxin
authors.initials: F
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Zhicen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Ji
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China. caolaoban6@163.com.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. caolaoban6@163.com.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China. caolaoban6@163.com.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China. caolaoban6@163.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongchen district, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.
authors.forename: Jizong
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D002536:Cerebral Arteries / Q000002:abnormalities*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: BAVMs supplied by deep perforating arteries; Lesion-to-eloquent fibre distance; Neurological deficits; Predominant supply