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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Long-term Outcomes of Patients With Giant Intracranial Arteriovenous Malformations
Wuyang Yang1, Zhikui Wei, Joanna Y Wang
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Giant arteriovenous malformations (AVMs) management requires careful consideration. Conservative treatment may offer similar or better outcomes than interventions, with comparable hemorrhage risks for giant AVMs.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Radiology
Background:
- Giant intracranial arteriovenous malformations (AVMs) are rare and challenging cerebrovascular lesions.
- Management strategies for these AVMs require further clarification regarding patient outcomes.
Purpose of the Study:
- To compare outcomes in patients with giant cerebral AVMs treated with conservative versus interventional therapies.
- To analyze functional outcomes and hemorrhage risks associated with different management approaches for giant AVMs.
Main Methods:
- Retrospective review of patients with intracranial AVMs (>6 cm) from 1990 to 2013.
- Comparison of outcomes between conservative management and interventional therapies (microsurgery, radiosurgery, embolization).
- Functional outcome assessment using the modified Rankin Scale (mRS).
Main Results:
- 55 patients with giant AVMs were included; 35 had follow-up (mean 11.8 years).
- Conservative management group had larger AVMs and more temporal lobe involvement.
- Hemorrhage risk was similar between conservative (2.7% annualized) and interventional (4.1% annualized) groups; trend towards better outcomes (mRS < 2) with conservative management (P = .06).
Conclusions:
- Interventions for giant AVMs warrant cautious consideration due to similar hemorrhagic risks.
- Conservative management may yield equivalent or superior functional outcomes compared to interventions for giant AVMs.
Background:
Giant intracranial arteriovenous malformations (AVMs) are rare cerebrovascular lesions that pose management challenges.
Objective:
To further clarify outcomes in patients with giant cerebral AVMs managed with conservative or interventional therapies.
Methods:
We performed a retrospective review of all patients diagnosed with AVMs evaluated at our institution from 1990 to 2013. Patients with a single intracranial AVM >6 cm were included. Patients were divided into 2 groups: conservative management or intervention (microsurgery, radiosurgery, or embolization). Functional outcome was assessed with the modified Rankin Scale (mRS) and compared between the 2 groups.
Results:
A total of 55 patients with giant AVMs were included, and 35 patients (63.6%) had clinical follow-up with a mean of 11.8 years. Spetzler-Martin grades were as follows: grade III, n = 2 (3.6%); grade IV, n = 15 (27.3%); and grade V, n = 38 (69.1%). Twenty-four patients (43.6%) were conservatively managed. The patients in the conservatively managed group had larger AVMs (P < .05) with more frequent involvement of the temporal lobe (P = .02). Five patients (26.3%) in the conservatively managed group and 5 (31.3%) in the intervention group experienced hemorrhage during follow-up, translating to an annualized risk of 2.7% and 4.1%, respectively. No significant difference in risk of first subsequent hemorrhage was observed (P = .78). Despite comparable mRS scores at presentation, we observed a trend toward better outcomes (mRS < 2) in patients undergoing conservative management (P = .06) compared with the intervention group at last follow-up.
Conclusion:
This study suggests that interventions for giant AVMs should be considered cautiously because hemorrhagic risk is similar regardless of management strategy and functional outcome is likely to be same or better in the conservatively managed population.
Abbreviations:
AVM, arteriovenous malformationmRS, modified Rankin Scale.
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