Neurological Surgery 脳神経外科51巻2号

2023年03月発行

特集 新時代を迎えた脳血管内治療—文献レビューで学ぶ進歩とトレンド Ⅱ 出血性病変

脳動静脈奇形〈適応と成績編〉

著者： 清末一路¹

所属機関： ¹熊本大学大学院生命科学研究部画像診断解析学

ページ範囲：P.251 - P.264

Point
・脳動静脈奇形（BAVM）の自然歴における脳出血年間発生率は未破裂例で約2.2%，破裂例で約4.5%程度とされる．また，出血の危険因子としてはAVMの存在部位（深部/テント下），流出静脈（単一の静脈流出，深部静脈流出のみ，静脈狭窄，流出静脈径 ＞ 5 mm），動脈瘤合併などが挙げられている．
・血管内治療は術前塞栓術から根治的塞栓術，また姑息的塞栓術など，さまざまな目的で行われ，BAVMの治療の中で重要な役割を果たしている．
・血管内治療の治療成績やその有用性は，BAVMの病態の複雑性と疾患の希少性，血管内治療デバイスの変化，治療目的と方法の違い，術者の経験値など，さまざまな要因に影響を受けることから，いまだ明確でない．
・上記を踏まえて，個々の症例におけるその適応は，術者・施設の合併症率などの治療のリスクと疾患のリスクを合わせて考慮されるべきである．

参考文献

1）De Leacy R, et al；SNIS Standards and Guidelines Committee, SNIS Board of Directors：Endovascular treatment in the multimodality management of brain arteriovenous malformations：report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 14：1118-1124, 2022

2）Al-Shahi R, et al：Prevalence of adults with brain arteriovenous malformations：a community based study in Scotland using capture-recapture analysis. J Neurol Neurosurg Psychiatry 73：547-551, 2002

3）Arteriovenous Malformation Study Group：Arteriovenous malformations of the brain in adults. N Engl J Med 340：1812-1818, 1999

4）Morris Z, et al：Incidental findings on brain magnetic resonance imaging：systematic review and meta-analysis. BMJ 339：b3016, 2009　doi：10.1136/bmj.b3016

5）Ogilvy CS, et al；Special Writing Group of the Stroke Council, American Stroke Association：AHA Scientific Statement：recommendations for the management of intracranial arteriovenous malformations：a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Stroke 32：1458-1471, 2001

6）Al-Shahi R, et al；Scottish Intracranial Vascular Malformation Study Collaborators：Prospective, population-based detection of intracranial vascular malformations in adults：the Scottish Intracranial Vascular Malformation Study（SIVMS）. Stroke 34：1163-1169, 2003

7）Gross BA, Du R：Natural history of cerebral arteriovenous malformations：a meta-analysis. J Neurosurg 118：437-443, 2013

8）Kim H, et al；MARS Coinvestigators：Untreated brain arteriovenous malformation：patient-level meta-analysis of hemorrhage predictors. Neurology 83：590-597, 2014

9）Mohr JP, et al；ARUBA co-investigators：Medical management with interventional therapy versus medical management alone for unruptured brain arteriovenous malformations（ARUBA）：final follow-up of a multicentre, non-blinded, randomised controlled trial. Lancet Neurol 19：573-581, 2020

10）Abecassis IJ, et al：Natural history of brain arteriovenous malformations：a systematic review. Neurosurg Focus 37：E7, 2014　doi：10.3171/2014.6.FOCUS14250

11）Sahlein DH, et al：Features predictive of brain arteriovenous malformation hemorrhage：extrapolation to a physiologic model. Stroke 45：1964-1970, 2014

12）Alexander MD, et al：Association between venous angioarchitectural features of sporadic brain arteriovenous malformations and intracranial hemorrhage. AJNR Am J Neuroradiol 36：949-952, 2015

13）de Castro-Afonso LH, et al；IntraCranial Arteriovenous RUpture riSk Study（ICARUSS）investigators：Association between draining vein diameters and intracranial arteriovenous malformation hemorrhage：a multicentric retrospective study. Neuroradiology 62：1497-1505, 2020

14）Stein KP, et al：Associated aneurysms in supratentorial arteriovenous malformations：impact of aneurysm size on haemorrhage. Cerebrovasc Dis 39：122-129, 2015

15）Platz J, et al：Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms. Acta Neurochir（Wien）156：2025-2034, 2014

16）Liu XJ, et al：Risk of cerebral arteriovenous malformation rupture during pregnancy and puerperium. Neurology 82：1798-1803, 2014

17）Liew JA, et al：Incidence of spontaneous obliteration in untreated brain arteriovenous malformations. Neurosurgery 86：139-149, 2020

18）Weber W, et al：Preoperative embolization of intracranial arteriovenous malformations with Onyx. Neurosurgery 61：244-252；discussion 252-254, 2007

19）Luzzi S, et al：Onyx embolization before the surgical treatment of grade Ⅲ Spetzler-Martin brain arteriovenous malformations：single-center experience and technical nuances. World Neurosurg 116：e340-e353, 2018　doi：10.1016/j.wneu.2018.04.203

20）Brosnan C, et al：Preoperative embolisation of brain arteriovenous malformations：a systematic review and meta-analysis. Neurosurg Rev 45：2051-2063, 2022

21）Park MT, et al：Surgical management outcomes of intracranial arteriovenous malformations after preoperative embolization：a systematic review and meta-analysis. Neurosurg Rev 45：3499-3510, 2022

22）Spetzler RF, Ponce FA：A 3-tier classification of cerebral arteriovenous malformations. Clinical article. J Neurosurg 114：842-849, 2011

23）Catapano JS, et al：Spetzler-Martin grade Ⅲ arteriovenous malformations：a multicenter propensity-adjusted analysis of the effects of preoperative embolization. Neurosurgery 88：996-1002, 2021

24）China M, et al：Gamma knife radiosurgery for cerebral arteriovenous malformations：a systematic review and meta-analysis. Neurosurg Rev 45：1987-2004, 2022

25）Letchuman V, et al：The era of Onyx embolization：a systematic and literature review of preoperative embolization before stereotactic radiosurgery for the management of cerebral arteriovenous malformations. World Neurosurg 170：90-98, 2023

26）Russell D, et al：Stereotactic radiosurgery alone or combined with embolization for brain arteriovenous malformations：a systematic review and meta-analysis. J Neurosurg 128：1338-1348, 2018

27）Oermann EK, et al：Effect of prior embolization on cerebral arteriovenous malformation radiosurgery outcomes：a case-control study. Neurosurgery 77：406-417；disucussion 417, 2015

28）Marks MP, et al：Embolization followed by radiosurgery for the treatment of brain arteriovenous malformations（AVMs）. World Neurosurg 99：471-476, 2017

29）Chen CJ, et al：Stereotactic radiosurgery with versus without embolization for brain arteriovenous malformations. Neurosurgery 88：313-321, 2021

30）Yu SC, et al：Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization：initial success and rate of permanent cure. AJNR Am J Neuroradiol 25：1139-1143, 2004

31）Katsaridis V, et al：Curative embolization of cerebral arteriovenous malformations（AVMs）with Onyx in 101 patients. Neuroradiology 50：589-597, 2008

32）Saatci I, et al：Endovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique：long-term results in 350 consecutive patients with completed endovascular treatment course. J Neurosurg 115：78-88, 2011

33）van Rooij WJ, et al：Curative embolization of brain arteriovenous malformations with onyx：patient selection, embolization technique, and results. AJNR Am J Neuroradiol 33：1299-1304, 2012

34）Durst CR, et al：A method for complete angiographic obliteration of a brain arteriovenous malformation in a single session through a single pedicle. J Clin Neurosci 22：391-395, 2015

35）Iosif C, et al：Curative endovascular treatment for low-grade Spetzler-Martin brain arteriovenous malformations：a single-center prospective study. J Neurointerv Surg 11：699-705, 2019

36）Mosimann PJ, Chapot R：Contemporary endovascular techniques for the curative treatment of cerebral arteriovenous malformations and review of neurointerventional outcomes. J Neurosurg Sci 62：505-513, 2018

37）Elsenousi A, et al：Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx：a meta-analysis. J Neurointerv Surg 8：265-272, 2016

38）Wu EM, et al：Embolization of brain arteriovenous malformations with intent to cure：a systematic review. J Neurosurg 132：388-399, 2019

39）Cai H, et al：Long-term efficacy and safety of curative embolization of brain arteriovenous malformations using the dual microcatheter technique：a single-institution case series and literature review. Clin Neurol Neurosurg 201：106417, 2021　doi：10.1016/j.clineuro.2020.106417

40）Nguyen TN, et al：Transvenous embolization of a ruptured cerebral arteriovenous malformation with en-passage arterial supply：initial case report. J Neurointerv Surg 2：150-152, 2010

41）He Y, et al：Safety and efficacy of transvenous embolization of ruptured brain arteriovenous malformations as a last resort：a prospective single-arm study. AJNR Am J Neuroradiol 40：1744-1751, 2019

42）Fang YB, et al：Transvenous embolization of brain arteriovenous malformations：a systematic review and meta-analysis. J Neurosurg Sci 63：468-472, 2019

43）Chen CJ, et al：Transvenous embolization of brain arteriovenous malformations：a review of techniques, indications, and outcomes. Neurosurg Focus 45：E13, 2018　doi：10.3171/2018.3.FOCUS18113

44）Mendes GAC, et al：Transvenous curative embolization of cerebral arteriovenous malformations：a prospective cohort study. Neurosurgery 83：957-964, 2018

45）Albuquerque FC, et al：Transvenous to arterial Onyx embolization. J Neurointerv Surg 6：281-285, 2014

46）Iosif C, et al：Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades. J Neurosurg 122：1229-1238, 2015

47）Deniwar MA, et al：Transvenous embolization of brain arteriovenous malformations：up-to-date meta-analysis. Turk Neurosurg 32：525-534, 2022

48）Volovici V, et al：Unruptured arteriovenous malformations：do we have an answer after the final follow-up of ARUBA? A Bayesian viewpoint. Stroke 52：1143-1146, 2021

49）Baranoski JF, et al：Seizure control for intracranial arteriovenous malformations is directly related to treatment modality：a meta-analysis. J Neurointerv Surg 6：684-690, 2014