Predictors of poor outcome, surgical nuances and clinical outcome of microsurgical excision of brain arterio-venous malformations: A single center experience

Abstract

BackgroundBrain arteriovenous malformations (bAVMs) are abnormal direct connections between arteries and veins forming a complex network of tangled vessels (nidus) leading to shunting of oxygenated blood directly into the veins without a true capillary bed. Digital Subtraction Angiography (DSA) is considered to be the gold standard to diagnose bAVMs. Microsurgical excision has better cure rates than embolization and/or radiosurgery. MethodsWe performed a retrospective review of 15 patients with bAVMs treated with craniotomy and microsurgical excision. At the final follow-up visit, the clinical outcome was measured using a postoperative modified Rankin Scale (mRS) score. Results13 (86.7 %) out of 15 patients had complete excision of the AVMs, while 2 patients (13.3 %) had partial obliteration with residual arterio-venous shunting. At the last follow up visit, 14 patients had Glasgow Coma Scale (GCS) between 13 and 15 and good mRS score (≤2). ConclusionFor low-grade bAVMs, microsurgical excision continues to offer the highest cure rate, outstanding clinical outcomes in both ruptured and unruptured AVMs, as well as optimal protection against haemorrhage; despite technological breakthroughs in endovascular and radiosurgical therapy.