Early versus Delayed Surgical Management of Ruptured Arteriovenous Brain Malformations in a Tertiary Referral Center in Colombia, South America

Abstract

IntroductionSurgical timing after rupture of brain arteriovenous malformations (AVMs) is controversial. There is scarce literature on AVM surgical outcomes from developing countries. This study aims to determine if there is a difference between early and delayed surgical resection for patients with ruptured brain AVMs. MethodsThis single-center retrospective review included patients who underwent surgical resection for ruptured brain AVMs in Colombia. Patients were stratified by the timing of surgical intervention relative to the rupture into early (≤72 hours of bleeding) and delayed (>72 hours) resection. Continuous variables were analyzed using an independent t-test, and dichotomous variables were analyzed using a chi-square test. A linear-regression analysis was performed with the final mRankin score at 2 years as the dependent variable; p<0.05 was considered significant. ResultsThirty-one patients were identified. The early treatment group included 14(45.2%) patients, and the delayed group, 17(54.8%) patients. The mean(SD) length of time between AVM rupture and surgical resection was 1.6±1.2 days and 12.4±8.4 days, respectively(p<0.001). There were no differences regarding demographics, perioperative variables and postoperative outcomes between groups. In the linear-regression analysis, the only variable that had a significant association with the final mRankin score was the initial GCS, which had a β coefficient of -0.6341(95%CI-0.41,-0.017,p=0.035) ConclusionIn this case series of 31 patients from a developing country, there were no differences in clinical outcomes at the final follow-up between acute and delayed surgical interventions for ruptured AVMs. The most important factor associated with the final outcomes was the initial GCS.