Seizure outcome in patients with surgically treated cerebral arteriovenous malformations

Abstract

A series of 280 cases of cerebral arteriovenous malformations (AVM's) treated surgically between June, 1970, and June, 1989, is reviewed with particular focus on the preoperative seizure history and follow-up seizure status. Follow-up evaluation (mean duration 7.5 years) was achieved in 98% of cases and was accomplished through re-examinations, telephone interviews, and written questionnaires. Overall, 89% of the surviving patients with a follow-up period of greater than 2 years were free of seizures at last examination. Of the 280 patients in this series, 163 had experienced no seizures preoperatively. A recent follow-up study (with a minimum duration of 2 years or to death) was available in 157 of these 163 cases; 21 patients had died. Of the 136 surviving patients, only eight (6%) were having new ongoing seizures. In the 128 (94%) who had remained seizure-free, 73% were receiving no anticonvulsant agents while 27% were taking anticonvulsant prophylaxis. The 2-year minimum follow-up study in 110 of the 117 patients with preoperative seizures revealed that eight (7%) had died. Of the 102 surviving patients, 85 (83%) were seizure-free (with 48% no longer receiving anticonvulsant therapy), while 17 (17%) still suffered intermittent seizures. However, of these 17 patients, 13 reported their seizures to be improved compared to preoperatively; the seizures were the same in two patients and were worse in two patients. An actuarial analysis was conducted comparing the life expectancy of patients following surgery for AVM's with the expected survival of a general white population of the same age and sex in the West Northcentral region of the United States. No statistically significant difference was found. There were seven perioperative deaths (three from cerebral hemorrhage, two from pulmonary emboli, and two from obstruction of venous drainage) and 22 deaths during the follow-up period. Of these 22 deaths, the cause was unknown in four patients, apparently unrelated to the AVM in 13, and directly or indirectly related to the patient's neurological condition prior to surgery or due to surgery performed for resection of the AVM in five. There was a statistically significant relationship between the size and location of the AVM and the clinical presentation. Patients with small AVM's (< 3 cm) were more likely to present with hemorrhage whereas those with large AVM's were more likely to present with seizures.(ABSTRACT TRUNCATED AT 400 WORDS)

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

“…6 Previous studies have indicated a higher risk for seizures in male patients, in patients with AVMs larger than 3 cm, in younger (< 18 years) patients, and in patients with superficial venous outflow drainage from a temporal lobe location. 10,12,17,18,31,39 Our study also found that males had a higher likelihood of seizure activity and that seizures were less common in younger patients, especially those younger than 18 years. Of interest, we also found that seizures were less common in patients who had sustained an intracranial hemorrhage.…”

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

“…Additionally, these surgically induced seizures may become progressively more intractable. 49,52,66 The reported risk of new-onset seizures after microsurgical resection varies widely, ranging from 3% to 32%. 1,19,29,33,52,66 In contrast, SRS appears to confer a lower seizure risk for patients without pretreatment seizures, with rates ranging from 0% to 7%.…”

“…49,52,66 The reported risk of new-onset seizures after microsurgical resection varies widely, ranging from 3% to 32%. 1,19,29,33,52,66 In contrast, SRS appears to confer a lower seizure risk for patients without pretreatment seizures, with rates ranging from 0% to 7%. 5,33,69 Current treatment options offer relatively effective seizure control with modality-specific risks and complications.…”

Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

“…29,30 Some reports [31][32][33] suggest that BAVM surgery allows good control of the seizure disorder. Treatment of such malformations is supposed to decrease the spontaneous risk associated with the malformation and/or cure the symptoms.…”