• Bradley A Gross and Rose Du.
• Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
• Neurosurgery. 2013 Jan 1; 72 (1): 253225-32; discussion 32.

BackgroundThe natural history and treatment results for spinal glomus (type II) arteriovenous malformations (AVMs) remain relatively obscure.ObjectiveTo calculate spinal glomus (type II) AVM hemorrhages rates and amalgamate results of intervention.MethodsWe performed a pooled analysis via the PubMed database through May 2012, including studies with at least 3 cases. Data on individual patients were extracted and analyzed using a Cox proportional hazards regression model to obtain hazard ratios for hemorrhage risk factors.ResultsThe annual hemorrhage rate before treatment was 4% (95% confidence interval [confidence interval]: 3%-6%), increasing to 10% (95% CI: 7%-16%) for AVMs with previous hemorrhage. The hazard ratio for hemorrhage after hemorrhagic presentation was 2.25 (95% CI: 0.71-7.07), increasing to 13.0 within the first 10 years (95% CI: 1.44-118). The overall rates of complete obliteration were 78% (95% CI: 72%-83%) for surgery and 33% (95% CI: 24%-43%) for endovascular treatment. Long-term clinical worsening occurred in 12% of patients after surgical treatment (95% CI: 8%-16%) and in 13% after endovascular treatment (95% CI: 7%-21%). No hemorrhages occurred after complete obliteration. After partial surgical treatment, the annual hemorrhage rate was 3% (95% CI: 1%-6%); no hemorrhages were reported over 196 patient-years after partial endovascular treatment.ConclusionSpinal glomus (type II) AVMs with previous hemorrhage, particularly within 10 years, demonstrated a greater risk of hemorrhage. Complete obliteration and even partial endovascular treatment significantly decreased their hemorrhage rate.

26 keywords...

hide…