Efficacy and Safety of Surgical Management for Cerebral Arteriovenous Malformations: A Study Involving 100 Cases

Cerebral arteriovenous malformations (AVMs) are congenital vascular anomalies that represent a significant surgical challenge due to their risk of bleeding and anatomical complexity. The Spetzler-Martin (SM) classification is a fundamental tool for predicting surgical risk and guiding treatment.

This study aimed to assess the clinical and functional outcome of microsurgical treatment in patients with AVMs according to their SM grading classification.

The present study employed a prospective, multicenter observational cohort of 100 consecutive patients with surgical resection of AVMs during January 2008 and May 2020 in four Mexico-based public and private hospitals. The AVMs were grouped based on the SM scale (grade I-V), and the data were taken at baseline, discharge, and six months after regarding the clinical, anatomical, and functional measures. The Glasgow Coma Scale (GCS) and the modified Rankin Scale (mRS) were taken as functional outcomes. The analysis of the data was based on descriptive statistics and nonparametric tests, specifically the Kruskal-Wallis test, with a significance level of 0.05.

A total of 62 patients (62%) had grade I and III AVMs. Functional recovery was complete in 30 patients (30%) with grade I AVMs and favorable in 22 patients (22%) with grade II AVMs. Greater variability in outcomes was observed in grade III AVMs. Grades IV and V presented greater morbidity and less functional recovery. Inferential analysis showed significant differences between the groups on the Rankin scale (p < 0.001), but not on the GCS (p = 0.178). During the follow-up of five years, no recurrences, rebleeding events, or mortality related to malformations arteriovenous or with the surgical procedure, demonstrating the effectiveness and safety of the long-term microsurgical treatment.

The SM classification is useful for predicting postoperative functional outcomes. Surgical treatment is more effective and safer for low-grade AVMs and should be performed in centers with neurovascular expertise.