Ruptured cerebral arteriovenous malformations: Outcomes analysis after microsurgery

Area of Science:

• Neurosurgery
• Vascular Neurology
• Radiology

Background:

• Recurrent arteriovenous malformations (rAVM) pose significant challenges in neurosurgical practice.
• Evaluating functional outcomes and residual risks post-treatment is essential for patient management.

Purpose of the Study:

• To assess the functional results and postoperative remnant rates in patients treated for rAVM via microsurgery.
• To identify predictors of favorable outcomes and residual malformations.

Main Methods:

• Retrospective analysis of 139 patients with rAVM treated between 2002 and 2012.
• Preoperative assessment included age, World Federation of Neurosurgical Societies (WFNS) score, and Stereotactic পরিসংখ্যান (SPM) grade.
• Postoperative evaluation at 3 months used the modified Rankin Scale (mRS), with conventional angiography at 2 weeks and 1 year.

Main Results:

• 83% of patients achieved a good functional outcome (mRS ≤2).
• Complete obliteration was achieved in 89.5% after initial microsurgery.
• A remnant rAVM was detected in 10.5% on early angiography, with recurrence in 4.5% (all <18 years old).
• Predictors of good outcome included younger age, lower WFNS and SPM grades, and absence of hydrocephalus.
• Predictors of remnant rAVM included higher WFNS and SPM grades and limited preoperative imaging.

Conclusions:

• Microsurgery offers good functional outcomes for the majority of rAVM patients.
• Even patients with poor initial neurological status can benefit from surgical intervention.
• Multidisciplinary discussion is vital for managing residual rAVM to mitigate rebleeding risk.