Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade.
BACKGROUND: Recent studies have questioned the utility of surgical resection of unruptured brain arteriovenous malformations (bAVMs).
OBJECTIVE: We performed an assessment of outcomes and complications of surgical resection of low-grade bAVMs (Spetzler-Martin grade I or II) at a single high-volume neurosurgical center.
METHODS: We reviewed all unruptured low-grade bAVMs treated with surgery (with or without preoperative embolization) between January 2004 and January 2014. Stroke rate, mortality, and clinical and radiographic outcomes were examined.
RESULTS: Of 95 patients treated surgically, 85 (25 grade I, 60 grade II) met inclusion criteria, and all achieved radiographic cure postoperatively. Ten patients (11.8%) were lost to follow-up; the mean follow-up of the remaining 85 was 3.3 years. Three patients (3.5%) with grade II bAVMs experienced a stroke; no patients died. Although 20 patients (23.5%) had temporary postoperative neurological deficit, only 3 (3.5%) had new clinical impairment (modified Rankin Scale score ≥2) at last follow-up. Eight of the 13 patients (61.5%) with preexisting clinical impairment had improved modified Rankin Scale scores of 0 or 1; and 17 of 30 patients (56.7%) with preoperative seizures were seizure-free without antiepileptic medication postoperatively. No significant differences existed in stroke rate or clinical outcome between grades I and II patients at follow-up (Fisher exact test, P = .55 and P > .99, respectively).
CONCLUSION: Surgical resection of low-grade unruptured bAVMs is safe, with a high rate of improvement in functional status and seizure reduction. Although transient postoperative neurological deficit was observed in some patients, permanent treatment-related neurological morbidity was rare.
ABBREVIATIONS: ARUBA, A Randomized Trial of Unruptured Brain Arteriovenous MalformationsbAVM, brain arteriovenous malformationmRS, modified Rankin Scale.
Medical Subject Headings
Adult; Aged; Embolization, Therapeutic; Female; Humans; Intracranial Arteriovenous Malformations; Lost to Follow-Up; Male; Middle Aged; Retrospective Studies; Safety; Treatment Outcome; Young Adult
Digital Object Identifier (DOI)
Moon, Karam; Levitt, Michael R; Almefty, Rami O; Nakaji, Peter; Albuquerque, Felipe C.; Zabramski, Joseph M; Wanebo, John E; McDougall, Cameron G; and Spetzler, Robert F, "Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade." (2015). Neurosurgery. 670.