Tổng quan hệ thống phân loại dị dạng động tĩnh mạch não trong việc đánh giá khuyến nghị điều trị mổ vi phẫu

Springer Science and Business Media LLC - Tập 44 - Trang 2571-2582 - 2021
Basil E. Grüter1,2, Wenhua Sun1,2, Jorn Fierstra1,2, Luca Regli1,2, Menno R. Germans1,2
1Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
2Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland

Tóm tắt

Khi đánh giá các dị dạng động tĩnh mạch não (bAVMs) cho việc cắt bỏ qua mổ vi phẫu, lịch sử tự nhiên của sự vỡ bAVM phải được cân nhắc so với các rủi ro trong và sau phẫu thuật. Do đó, cần có một hệ thống phân loại phẫu thuật đáng tin cậy, cân bằng những yếu tố quan trọng này. Nghiên cứu này tiến hành xem xét có hệ thống tài liệu để xác định và đánh giá chất lượng của các hệ thống phân loại liên quan đến điều trị bAVM qua mổ vi phẫu. Một cuộc tổng quan tài liệu có hệ thống đã được thực hiện để cung cấp cái nhìn tổng quát về tất cả các hệ thống phân loại bAVM có sẵn liên quan đến đánh giá điều trị vi phẫu và để đánh giá hệ thống phân loại toàn diện nhất cho từng phân nhóm bAVM (tức là, chưa vỡ, đã vỡ, và hố sau). Việc sàng lọc 865 tài liệu đã phát hiện mười ba hệ thống phân loại cho phân tầng rủi ro vi phẫu bAVM. Trong số đó, hai hệ thống được phát triển đặc biệt cho trường hợp bAVM đã vỡ và một hệ thống dành riêng cho bAVM khu vực hố sau. Với một hệ thống cơ bản khác biệt dành cho bAVM ở trên vòm sọ, chín hệ thống còn lại sử dụng cùng các tham số: “kích thước”, “tính quan trọng”, “drenage tĩnh mạch”, “cung cấp động mạch”, “tuổi tác”, “độ chặt của nidus”, và “hình thức xuất huyết”. Nghiên cứu này cung cấp cái nhìn toàn diện về tất cả các hệ thống phân loại bAVM có sẵn liên quan đến phân tầng rủi ro phẫu thuật. Hơn nữa, trong bối cảnh thiếu một hệ thống phổ quát phù hợp để đánh giá tất cả bAVMs, một quy trình làm việc cho việc lựa chọn hệ thống phân loại tốt nhất phù hợp theo các phân nhóm bAVM được trình bày.

Từ khóa

#dị dạng động tĩnh mạch não #phân loại #mổ vi phẫu #rủi ro phẫu thuật

Tài liệu tham khảo

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