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Optimal Timing of Microsurgical Treatment for Ruptured Arteriovenous Malformations: A Systematic Review and
Atakan Orscelik1, Basel Musmar2, Hidetoshi Matsukawa1,3
1Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston , South Carolina , USA.
Neurosurgery
|June 24, 2024
Summary
Delayed microsurgical treatment (MST) for ruptured brain arteriovenous malformations (bAVMs) beyond 48 hours is linked to better patient outcomes. This approach, with or without endovascular treatment, shows improved recovery rates and reduced mortality in ruptured bAVMs.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- The optimal timing for microsurgical treatment (MST) of ruptured brain arteriovenous malformations (bAVMs) remains debated.
- This study addresses the impact of MST timing on patient outcomes, considering interventions with and without preoperative endovascular treatment (EVT).
Purpose of the Study:
- To investigate the association between the timing of microsurgical treatment (MST) and outcomes in patients with ruptured brain arteriovenous malformations (bAVMs).
- To compare outcomes for MST performed at different intervals after bAVM rupture, including procedures with and without prior EVT.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Included 15 studies, categorizing patients into MST timing groups: <48 hours, <1 week, <2 weeks, and <1 month.
- Primary outcome: favorable outcome (modified Rankin Scale 0-2 or Glasgow Outcome Scale 4-5); Secondary outcomes: mortality and complete excision.
Main Results:
- MST performed after 48 hours was associated with significantly higher favorable outcome rates (OR: 9.71) and lower mortality rates (OR: 0.15) compared to MST within 48 hours.
- Even after excluding patients who received preoperative EVT, MST after 48 hours still showed a significantly higher rate of favorable outcomes (OR: 9.39).
Conclusions:
- Delayed MST beyond 48 hours appears to be associated with improved favorable outcomes for ruptured bAVMs.
- This finding holds true for both MST alone and MST combined with preoperative EVT.
