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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Ruptured cerebral arteriovenous malformations: Outcomes analysis after microsurgery
Rabih Aboukaïs1, Paulo Marinho1, Marc Baroncini1
1Department of Neurosurgery, Lille University Hospital, France.
Objective:
Our study aimed to evaluate the functional outcome and the risk of postoperative remnant in patients with rAVM after microsurgical treatment.
Materials And Methods:
This is a retrospective of 139 consecutive patients operated for a rAVM between 2002 and 2012 in our institution. The age at diagnosis and the WFNS score were recorded for each patient before treatment. All patients were re-evaluated 3 months after treatment using mRS scale. Conventional angiography was performed in the first 2 postoperative weeks and then a year later to detect any remnant or recurrence.
Results:
The mean age at diagnosis was 30.8 years (range 4-69 SD: ±5) and 44 patients had an age at diagnosis <18 yo. The mRS score 3 months after treatment was ≤2 in 104 patients (83%). Predictive factors of good functional outcome were age at diagnosis <25 yo, initial WFNS score ≤ 2, SPM grade ≤ 2 and absence of acute hydrocephalus (p<0.05). Complete obliteration was obtained in 123 patients (89.5%) after the first microsurgical treatment. Early postoperative conventional angiography revealed a rAVM remnant in 16 patients (10.5%). Late conventional angiography showed a recurrence in 6 patients (4.5%). All of them were <18 yo. Predictive factors of postoperative rAVM remnant were an initial WFNS score>2, SPM grade>2 and preoperative evaluation limited only to CT angiography in emergency situation (p<0.05).
Conclusion:
Functional outcome after microsurgical treatment was good in 83% of patients with rAVM. Good results were also recorded in 28% of patients with poor initial neurological status and severe intracerebral hemorrhage, which required immediate surgery. In case of remnant, a further treatment should be decided in a true multidisciplinary discussion to protect the patient from any rebleeding.
Insights
Microsurgical treatment for ruptured arteriovenous malformations (rAVM) yielded good functional outcomes in 83% of patients. Careful consideration of residual rAVM is crucial to prevent rebleeding.
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.
