Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors conducted a study to assess the safety and efficacy of microsurgical resection of arteriovenous malformations (AVMs) and determine predictors of complications.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A total of 264 patients with cerebral AVMs were treated with microsurgical resection between 1994 and 2010 at the Jefferson Hospital for Neuroscience. A review of patient data was performed, including initial hemorrhage, clinical presentation, Spetzler-Martin (SM) grade, treatment modalities, clinical outcomes, and obliteration rates. Univariate and multivariate analyses were used to determine predictors of operative complications.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of the 264 patients treated with microsurgery, 120 (45%) patients initially presented with hemorrhage. There were 27 SM Grade I lesions (10.2%), 101 Grade II lesions (38.3%), 96 Grade III lesions (36.4%), 31 Grade IV lesions (11.7%), and 9 Grade V lesions (3.4%). Among these patients, 102 (38.6%) had undergone prior endovascular embolization. In all patients, resection resulted in complete obliteration of the AVM. Complications occurred in 19 (7.2%) patients and resulted in permanent neurological deficits in 5 (1.9%). In multivariate analysis, predictors of complications were increasing AVM size (OR 3.2, 95% CI 1.5–6.6; p = 0.001), increasing number of embolizations (OR 1.6, 95% CI 1.1–2.2; p = 0.01), and unruptured AVMs (OR 2.7, 95% CI 1–7.2; p = 0.05).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of morbidity at high-volume neurovascular centers. Unruptured and larger AVMs were associated with higher complication rates.</jats:p></jats:sec>

Microsurgery for intracranial arteriovenous malformation: Long-term outcomes in 445 patients

“…[45] Theofanis et al reported 264 patients treated with microsurgery and showed rates of permanent surgical morbidity and mortality of 1.9% and 2.7%, respectively, with an obliteration rate of 100%. [46]We presented a cohort comprising 445 patients treated with microsurgical resections in a large single center, and illustrated a permanent postoperative morbidity of 14.8% and a mortality of 7.9%. Even minor changes such as hydrocephalus or a small visual field deficit were assessed and rated as a deficit.…”

Microsurgery for cerebral arteriovenous malformations: subgroup outcomes in a consecutive series of 288 cases

“…3,26 On the contrary, 2 studies found increased complication rates after preembolization. 15,28 In the 1990s and early 2000s, embolization series usually showed a comparable rate of new deficits (0%-22%) and even certain mortality (0%-4.3%). 19,29 A recent review of approximately 1300 mostly low-grade AVMs found a mortality rate of 1.6%, morbidity rate of 6.2%, and an occlusion rate of 29%.…”

Surgical Management of Giant Intracranial Arteriovenous Malformations: A Single Center Experience over 32 years

“…Microsurgical resection, in select cases, can offer durable and high cure rates with immediate elimination of future hemorrhage risk (5,34,40). Preoperative endovascular embolization using particle or liquid embolic materials may potentially make surgical excision of these AVMs less daunting by reducing operative time and decreasing blood loss (10,41).…”

“…Microsurgery continues to play a role, albeit controversial, in the treatment of AVMs despite remarkable advances in radiosurgery and endovascular techniques (5)(6)(7)(8)(9)(10)(11)(12).…”