Surgical Excision of Cerebral Arteriovenous Malformations: Late Results

Abstract

A follow-up study of 153 consecutive patients who underwent complete excision of an angiographically visualized intracerebral arteriovenous malformation was conducted. The follow-up period ranged from 0.5 to 10.6 years, with a mean of 3.8 years. The presenting clinical event was hemorrhage in about one-half of the patients and seizure in about one-third. There was a marked tendency for postoperative neurological deficits to improve with time, so that whereas the immediate postoperative rate of serious morbidity was 24.2%, only 7.8% of the patients were found to have serious morbidity at follow-up. An additional 3 patients had died. one of an unrelated carcinoma, making the mortality related to arteriovenous malformation 1.3%. The classification of Spetzler and Martin (43) was used retrospectively; the percentages of Grade I (easiest) through Grade V (most difficult) lesions were 7.8%, 22.9%, 28.8%, 26.8%, and 13.8%, respectively. The early result was well correlated to grade, with good or excellent results in 100%, 94.3%, 88.6%, 61%, and 28.6% of the patients in Grades I through V, respectively. At follow-up, 98.7% of the patients with arteriovenous malformations of Grades I, II, and III were in good or excellent condition. The late morbidity and mortality rates for the patients in Grades IV and V were 12.2% and 38.4%, respectively. Of the patients who did not have seizures before surgery, 8.2% had only one or two seizures during the immediate postoperative period, and 7.1% had late seizures that were well controlled with medication in all. Of the patients who had seizures before surgery, over half were either cured or greatly improved with respect to the seizures. In 32.7% there was no change in the frequency of the seizures, and in 12.7% the seizures were more frequent after surgery. There was no history of either proven or suspected intracranial hemorrhage in any of the patients during the entire follow-up period, which in the aggregate totalled 556.3 years.

Natural course of the arteriovenous malformations of the brain initially presented by hemorrhage – analysis of a clinical series of 39 patients

“…Since AVMs of the brain do not have such a high risk of repeated hemorrhage as aneurysms and an average incidence of 0.14%, this makes possible elective approach when selecting the therapy option (surgery, embolization, radio surgery) (9,18,20,31).…”

Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report

“…There is a high propensity (80%) for the AVM childhood to present bleeding 8 , what is higher than that reported for adults 9,[15][16][17] . Likewise, epilepsy was reported in 12-18%of the AVM` s children series 7,18 and in 16 to 53% of the adult patients 19,20 .…”

Manejo actual de las malformaciones arteriovenosas: Estudio retrospectivo de 31 casos y revisión de la literatura

“…Coincidiendo con otros autores, se deben tener en cuenta también otros factores como son la forma de presentación (principalmente la hemorragia) 6,11,13,30 , la edad 17 , el estado clínico del paciente 17,19,44 y las características angioestructurales de la MAV 8,37 (aportes arteriales profundos, aneurismas intranidales).…”

“…El tratamiento de elección sería la cirugía, quedando en casos muy seleccionados (lesiones profundas) la radiocirugía y/o la embolización 14,19,31,32 . En las MAVs grado V se optaría por tratamiento conservador salvo casos muy seleccionados 15,20,31,32,39 .…”

“…Según este dato, si calculamos el riesgo de morbimortalidad acumulado de las MAVs que han sangrado, resulta un 24% de morbimortalidad a los 10 años y un 42% a los 20 años. Por otro lado, los resultados del tratamiento activo de MAVs de alto grado muestran un 7 al 17% de morbimortalidad en las MAVs grado IV y un 12 al 38,4% en las grado V 4,8,14,15,19 . Analizando estos resultados podemos llegar a la conclusión de que la historia natural, sobre todo en pacientes jóvenes, acaba por presentar una morbimortalidad acumulada superior a la del tratamiento a largo plazo.…”