Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes-A Retrospective Study of 25 Cases

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Ruptured brain arteriovenous malformations (bAVMs) present significant treatment challenges, particularly regarding the optimal timing of surgical intervention.
• Understanding the factors influencing surgical timing and patient outcomes is crucial for improving treatment strategies.

Purpose of the Study:

• To investigate the impact of various parameters on surgical timing and outcomes in patients with ruptured bAVMs.
• To determine the most influential factors affecting early and delayed surgical results.

Main Methods:

• A retrospective study of 25 patients who underwent surgery for ruptured bAVMs between 2010 and 2018.
• Patients were categorized into "early surgery" and "delayed surgery" groups.
• Hemorrhage severity was assessed using the Intracerebral Hemorrhage (ICH) score, AVM architecture by the Spetzler-Martin scale, and outcomes by the modified Rankin Scale (mRS).

Main Results:

• The "early surgery" group (11 patients) showed less favorable outcomes (36.4% at 3 months, 54.5% at 1 year) compared to the "delayed surgery" group (14 patients) (78.6% at 3 months, 92.8% at 1 year).
• Early outcomes were more strongly influenced by the ICH score, while delayed outcomes were more dependent on the Spetzler-Martin grading.
• Younger patients with a high ICH score and low AVM grade may benefit from early surgical intervention.

Conclusions:

• Delayed surgical intervention for ruptured bAVMs, allowing a rest period post-hemorrhage, generally leads to better long-term outcomes.
• The ICH score is a key determinant of early surgical results, whereas the Spetzler-Martin grade influences delayed outcomes.
• Early surgery can be a feasible strategy for specific patient profiles, including young individuals with high ICH scores and low AVM grades.