Abstract / Summary
Abstract Purpose To identify the independent risk factors for major blood loss during resection of cerebral arteriovenous malformations (AVMs). Methods This study included 250 patients with brain AVMs who underwent microsurgical resection between January 2018 and December 2021. Patients were divided into a major intraoperative blood loss (MIBL) group (≥ 500 mL) and a non-major intraoperative blood loss (N-MIBL) group (< 500 mL). Clinical, anatomical, angioarchitectural, and quantitative digital subtraction angiography (QDSA)-derived hemodynamic parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify independent factors associated with MIBL, and ROC curve analysis was used to assess the factor performance. Results Multivariate analysis showed that larger maximum diameter (OR = 1.03, 95% CI: 1.01–1.05, P = 0.024), presence of deep perforating artery (OR = 2.12, 95% CI: 1.12–4.02, P = 0.021), and higher D TRV (OR = 1.23, 95% CI: 1.07–1.42, P = 0.004) were independent risk factors for MIBL. In contrast, the presence of a single draining vein showed a trend to be protective (OR = 0.57, 95% CI: 0.32–1.01, P = 0.055). The optimism-corrected AUC of the multivariate model incorporating these three variables was 0.68 (95%CI: 0.64–0.71) for predicting MIBL. The optimal cutoff value for maximum diameter was 2.6 cm (sensitivity: 0.62, specificity: 0.64), and the optimal cutoff value for D TRV was 1.93 (sensitivity:0.66, specificity: 0.55). Conclusion Higher D TRV, along with deep perforating artery and larger maximum diameter, were associated with increased intraoperative blood loss. Clinical Trial Registration This study was a retrospective study using prospective national multicenter registry data from the Registry of Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China (the MATCH registry, ClinicalTrials.gov register, NCT 04572568).