219 A Proposed Technique for Early Venous Sacrifice as an Alternative to Standard Yasargil Technique for Resection of Cerebral AVM's

Abstract

INTRODUCTION: This study introduces an alternative technique to the standard Yasargil resection of AVMs. METHODS: This 20-year prospective observational study compared the outcomes of 510 consecutive patients undergoing resection of AVM using either the early venous sacrifice technique (test group, n = 206) or a historical control group who underwent AVM resection using standard technique (Yasargil Technique, n = 304). RESULTS: The test group had significantly more Grade II (35% vs 30.3%) and Grade III (45.1% vs 38.8%) AVMs, while the control group had significantly more Grade I (40.4% vs 7.8%) AVMs. There was no difference in the number of Grade IV or Grade V AVMs. Overall, the test group presented with higher grade AVMs than the control group. Outcomes analyzed included post-operative stroke (CVA), death, modified Rankin Scale (mRS) score, need for blood transfusion, and incomplete obliteration of the AVM. Patients in the test group were 58% less likely to require blood transfusion compared to control (5.8% vs 13.8%, 58% RRR, NNT = 12.5, p = 0.004). Although not statistically significant, there was a trend toward reduced risk of CVA (RRR = 26%), post-operative mRS = 3 (RRR = 30%), and death (RRR = 51%) in the test group relative to the traditional Yasargil technique. CONCLUSIONS: In the proposed technique the number of patients requiring blood transfusions was reduced by 1 for every 12.5 patients treated with the standard technique. The number of patients experiencing poor mRS (>3) was reduced by 1 for every 48.7 patients treated. The number of patients experiencing post- operative CVA was reduced by 1 for every 58 patients treated.