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The prospective natural history of cerebral venous malformations.

机译：脑静脉畸形的前瞻性自然史。

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OBJECTIVE: A 10-year prospective clinical and magnetic resonance imaging study was undertaken to determine the natural history of venous malformations. We assessed the hemorrhage rate and morbidity associated with venous malformations of the brain. PATIENTS AND METHODS: From 1986 to 1996, 80 patients with venous malformations were referred to the University of Pittsburgh multidisciplinary vascular malformation study group for evaluation. Observation was recommended for all patients. Follow-up clinical information was obtained from patients or their referring physicians through questionnaire or phone conversation. RESULTS: Twenty-two patients presented with neurological signs or symptoms that were thought to be related to the malformations (nine with headaches, four with seizures, three with sensory symptoms, three with motor deficits, two with trigeminal neuralgia, and one with an extrapyramidal disorder). Twenty-three patients presented with headaches that were not considered to be related to the malformations. The retrospective hemorrhage rate (from birth to study entry) was 0.61% (18 bleeds in 2,949 patient-years). Sixteen patients had sustained previous brain hemorrhage in the region of the venous malformations, two of whom had suffered subsequent hemorrhage. During the prospective follow-up period totaling 298 patient-years of clinical observation, two patients suffered hemorrhage (0.68% per year), but only one had a symptomatic bleed (0.34% per year). This patient had not hemorrhaged previously. One of these patients remained asymptomatic, whereas the second developed temporary worsening of facial paresthesias. No patient died as a result of the venous malformations. CONCLUSION: The hemorrhage rate of a patient with venous malformations is similar to the rates presented in previous reports for patients with cavernous malformations without previous symptomatic hemorrhage. We think that hemorrhage in a patient with venous malformations may be related to an underlying but not yet documented cavernous malformation. Because of the low risk for new neurological events, we advocate conservative management. The risks associated with surgical intervention greatly exceed the low risk of morbidity related to venous malformation hemorrhage.
机译：目的：进行了为期十年的前瞻性临床和磁共振成像研究，以确定静脉畸形的自然病史。我们评估了与脑静脉畸形相关的出血率和发病率。患者与方法：从1986年至1996年，将80例静脉畸形患者转入匹兹堡大学多学科血管畸形研究小组进行评估。建议对所有患者进行观察。通过问卷或电话交谈从患者或其转诊医师那里获得随访的临床信息。结果：22例患者表现出与畸形相关的神经系统体征或症状（9例头痛，4例癫痫发作，3例感觉症状，3例运动功能障碍，2例三叉神经痛和1例锥体外系神经痛紊乱）。 23名患者表现出与畸形无关的头痛。回顾性出血发生率（从出生到研究进入）为0.61％（2,949患者年中有18处出血）。 16名患者先前在静脉畸形区域持续出现脑出血，其中2名患者随后发生了出血。在前瞻性随访期间，共298例患者-年的临床观察，其中2例发生了出血（每年0.68％），但只有1例出现了出血现象（每年0.34％）。该患者先前未出血。其中一名患者无症状，而第二名患者出现面部感觉异常暂时恶化。没有患者因静脉畸形而死亡。结论：静脉畸形患者的出血率与先前报道的无先前症状性出血的海绵畸形患者的出血率相似。我们认为静脉畸形患者的出血可能与潜在的但尚未记录的海绵状畸形有关。由于发生新的神经系统事件的风险较低，因此我们提倡保守治疗。与外科手术相关的风险大大超过了与静脉畸形出血相关的低发病风险。

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