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Surgical excision of cerebral arteriovenous malformations: late results
R C Heros1, K Korosue, P M Diebold
1Neurosurgical Service, Massachusetts General Hospital, Boston.
Insights
Complete surgical removal of brain arteriovenous malformations significantly reduces long-term risks. Post-operative neurological deficits improve over time, with low rates of serious morbidity and mortality for surgically treated arteriovenous malformations.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Intracerebral arteriovenous malformations (AVMs) pose significant risks, including hemorrhage and neurological deficits.
- Complete surgical excision is a primary treatment modality for select AVMs.
- Long-term outcomes and risk stratification are crucial for patient management.
Purpose of the Study:
- To evaluate the long-term outcomes following complete surgical excision of intracerebral arteriovenous malformations.
- To assess the correlation between Spetzler-Martin grade and surgical results.
- To determine the rates of morbidity and mortality in relation to AVM grade.
Main Methods:
- Follow-up study of 153 consecutive patients undergoing complete AVM excision.
- Retrospective classification using the Spetzler-Martin grading system.
- Assessment of neurological deficits, morbidity, mortality, and seizure control at a mean follow-up of 3.8 years.
Main Results:
- Immediate postoperative morbidity was 24.2%, decreasing to 7.8% at follow-up.
- Mortality related to AVMs was 1.3%.
- Excellent outcomes were achieved in 98.7% of patients with Spetzler-Martin Grades I-III AVMs.
- Morbidity and mortality rates for Grades IV and V were 12.2% and 38.4%, respectively.
- Seizure control improved significantly in over half of pre-operative seizure patients.
Conclusions:
- Complete surgical excision of intracerebral AVMs leads to favorable long-term outcomes with significant reduction in morbidity.
- The Spetzler-Martin grade is a strong predictor of early and late surgical results.
- Surgical management of AVMs is associated with acceptable long-term risks, particularly for lower-grade lesions.
Abstract:
A follow-up study of 153 consecutive patients who underwent complete excision of an angiographically visualized intracerebral arteriovenous malformation was conducted. The follow-up period ranged from 0.5 to 10.6 years, with a mean of 3.8 years. The presenting clinical event was hemorrhage in about one-half of the patients and seizure in about one-third. There was a marked tendency for postoperative neurological deficits to improve with time, so that whereas the immediate postoperative rate of serious morbidity was 24.2%, only 7.8% of the patients were found to have serious morbidity at follow-up. An additional 3 patients had died, one of an unrelated carcinoma, making the mortality related to arteriovenous malformation 1.3%. The classification of Spetzler and Martin (43) was used retrospectively; the percentages of Grade I (easiest) through Grade V (most difficult) lesions were 7.8%, 22.9%, 28.8%, 26.8%, and 13.8%, respectively. The early result was well correlated to grade, with good or excellent results in 100%, 94.3%, 88.6%, 61%, and 28.6% of the patients in Grades I through V, respectively. At follow-up, 98.7% of the patients with arteriovenous malformations of Grades I, II, and III were in good or excellent condition. The late morbidity and mortality rates for the patients in Grades IV and V were 12.2% and 38.4%, respectively. Of the patients who did not have seizures before surgery, 8.2% had only one or two seizures during the immediate postoperative period, and 7.1% had late seizures that were well controlled with medication in all. Of the patients who had seizures before surgery, over half were either cured or greatly improved with respect to the seizures.(ABSTRACT TRUNCATED AT 250 WORDS)