Clinical aspects, management and outcome of brain arteriovenous malformations – results with microsurgery first policy

Abstract

Abstract We performed a retrospective study, including patients operated for brain AVMs between 1999 and 2014, in the Clinic of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni, Bucharest. 277 patients underwent surgery for brain AVMs. Mean age was 29.82 years. 195 patients (70.40%) presented with hemorrhage and 86 cases (31.05%) were admitted with seizures. We performed total resection of AVMs in 228 cases (82.31%) and subtotal resection in 49 cases (17.69%). Regarding patients with residual nidus, 16 of them underwent second surgery, 27 stereotactic radiosurgery Gamma Knife, 3 embolization and 3 refused further treatment. Modified Rankin Scale (mRS) improved following surgery (Z = -9.248, p = 0.000). Early complications (0-30 days) were encountered in 84 patients (30.32%). We found the following risk factors for postoperative complications occurrence: motor deficit (p = 0.006), co-morbidities (p = 0.023), higher mRS (p = 0.005), lower Karnofsky score (p = 0.003), lower GCS (p = 0.016), profound nidus (p = 0.001), eloquent aria (p = 0.000), large nidus (p = 0.000), multiple arterial territory (p = 0.000), deep feeding arteries (p = 0.000), higher number of feeding arteries (p = 0.000), deep venous drainage (p = 0.000), multiple draining veins (p = 0.000), higher Spetzler- Martin grade (p = 0.006), high flow (p = 0.000), vascular steel (p = 0.000), associated aneurysms (p = 0.010) and decompressive craniectomy (p = 0.019). Mortality was 6.1%. Microsurgery is the treatment of choice for brain AVMs. Surgical results are excellent, with low morbidity and mortality. Patients with poor surgical results belonged to the group admitted with severe altered general state, state of consciousness, massive hematomas and acute brainstem dysfunction. If part of the nidus cannot be safely surgical resected, stereotactic radiosurgery can provide definitive cure of the lesion.