[Neurologic findings before and after removal of cerebrovascular abnormalities]

In a retrospective serie the results of 72 cerebral vascular malformations, operated on consecutively were reviewed: 57 AV-malformations (in 55 patients), 1 dura AV-malformation, 9 cavernomas, 1 telangiectasia, 2 venous angiomas and 2 mixed malformations. The most frequent initial symptoms were headache, epileptic seizures and intracranial bleeding. In 5 cases the initial symptom was loss of consciousness with coma. A total resection could be proved angiographically in all cases. Mortality was 0%, neurological morbidity, i.e., new deficits or increase of existing deficits, was 8.6%. There were no recurrences of bleeding in the postoperative period. Quality of life, as assessed by the Karnofsky Index 6 months postoperatively, was satisfactory, approximately 80% of all patients being back at work. In this group of selectively operated patients it could be shown that localization of the malformation in or close to an eloquent brain area (n = 32) is rarely associated with significant persisting new deficits. Taking into consideration the natural history of AV malformations, with an 8% morbidity and 2% mortality each year, as compared to the surgical results, it is concluded that surgery may be more often indicated for AV malformations than was previously thought, even when they are near eloquent brain areas and relatively large in diameter.