Microsurgery for intracranial arteriovenous malformation: Long-term outcomes in 445 patients

• Published in: PloS one 2017-03, Vol.12 (3), p.e0174325-e0174325
• Main Authors: Ren, Qingqing, He, Min, Zeng, Yunhui, Liu, Zhiyong, Liu, Hao, Xu, Jianguo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Birth defects; Care and treatment; Cerebrovascular system; Child; Child, Preschool; Clinical trials; Combined Modality Therapy - methods; Demographics; Embolization, Therapeutic - methods; Evaluation; Female; Follow-Up Studies; Grading; Health aspects; Hemorrhage; Hemorrhage - physiopathology; Hemorrhage - surgery; Humans; Infant; Intracranial Arteriovenous Malformations - mortality; Intracranial Arteriovenous Malformations - surgery; Lesions; Male; Medical schools; Medicine and Health Sciences; Microsurgery; Microsurgery - methods; Middle Aged; Morbidity; Mortality; Multivariate analysis; Neurological diseases; Neurosurgery; Neurosurgical Procedures - methods; Patients; People and Places; Quality; Radiosurgery - methods; Research and Analysis Methods; Retrospective Studies; Statistical analysis; Surgery; Treatment Outcome; Young Adult; Young adults
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0174325

The management of intracranial arteriovenous malformations(AVMs) poses challenges to the cerebrovascular specialists. To review the long-term outcomes of intracranial AVMs treated with microsurgical resections. We performed a retrospective review of 445 patients with intracranial AVMs treated in our hospital from January 1st, 2008 to December 31st, 2014. The extracted data included demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, Supplemented Spetzler-Martin (SM-Supp) Grades, treatment modalities, long-term outcomes, and obliteration rates. Outcome was assessed with a post-operative modified Rankin Scale (mRS) score at the last follow-up visit. Of the 445 patients treated with microsurgery, 298 (67.0%) patients initially presented with hemorrhage. Based on the SM grading system, the patients were graded as follows: 83(18.6%) Grade I, 156(35.1%) Grade II, 132(29.7%) Grade III, 61(13.7%) Grade IV and 13(2.9%) Grade V. Overall, 344(77.3%) patients had a favorable outcome (mRS score of 0-2). The favorable outcome for Grade I and II were 92.8% and 85.9%, respectively, sharply reducing to 52.5% in patients with Grade IV and 15.4% in patients with Grade V AVMs. 388(87.2%) patients achieved complete obliteration of the AVMs. 63(14.2%) patients experienced recurrent hemorrhage, and the frequency of rehemorrhage was highest in Grade V patients (77.0%), dropping to 3.6% and 3.8% in patients with Grade I and II lesions, respectively. Permanent neurological deficits occurred in 66(14.8%) patients and death in 35(7.9%) patients. There was no difference of AUROC values between SM grading system and SM-supp grading system (0.726 and 0.734, respectively, p = .715). The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Microsurgical resection for AVMs depends on the SM grades, and the morbidity-mortality rate increases with an increasing SM grade.