Current surgical results with low-grade brain arteriovenous malformations

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Brain arteriovenous malformations (AVMs) are complex vascular lesions.
• Surgical resection offers a high cure rate for AVMs.
• The ARUBA trial's findings influenced treatment paradigms, particularly for unruptured AVMs.

Purpose of the Study:

• To evaluate the safety, efficacy, and outcomes of surgical resection for low-grade Spetzler-Martin Grade I and II brain AVMs.
• To clarify the role of surgery in the context of recent trial data.
• To assess outcomes in both ruptured and unruptured AVMs.

Main Methods:

• Prospective registry analysis of 232 patients with Spetzler-Martin Grade I and II AVMs.
• Patients underwent surgical resection over a 16-year period.
• Preoperative embolization was utilized in 43% of cases.

Main Results:

• Surgical resection was successfully completed in all patients, with angiographic confirmation in 94%.
• Overall good outcomes (mRS 0-1) were achieved in 78% of patients.
• Patients with unruptured AVMs demonstrated significantly better functional outcomes (91%) compared to ruptured AVMs (65%).

Conclusions:

• Surgical resection remains the gold standard for the majority of low-grade AVMs, offering the best cure rate and lowest risk profile.
• Preoperative embolization can serve as a valuable adjunct to surgery.
• Further randomized trials are needed to definitively reestablish the role of surgery in managing unruptured AVMs.