High-grade arteriovenous malformations and their management

• Published in: Journal of clinical neuroscience 2002, Vol.9 (1), p.37-40
• Main Authors: FERCH, Richard D, MORGAN, Michael K
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cerebral Angiography; Cerebral Hemorrhage - mortality; Embolization, Therapeutic; Female; Humans; Intracranial Arteriovenous Malformations - mortality; Intracranial Arteriovenous Malformations - surgery; Intracranial Arteriovenous Malformations - therapy; Intraoperative Complications - mortality; Male; Medical sciences; Nervous System Diseases - etiology; Neurosurgery; Postoperative Complications - mortality; Prospective Studies; Skull, brain, vascular surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1054/jocn.2000.0927

The aim of this study was to compare operatively and non-operatively managed high-grade arteriovenous malformations (AVMs) and to identify risk factors for surgical morbidity. Three hundred and ninety-one consecutively enrolled patients with AVMs were graded using the Spetzler Martin grading scheme. Forty-six of these patients had grade 4 or 5 AVMs. Twenty-nine patients underwent surgery and 17 were conservatively managed. During an average of 33 months follow-up the non-operative group experienced a decline in function in 27% of cases followed. These deteriorations were due to haemorrhage, progressive neurological deficits and seizures. In the surgical group completing treatment there was a mortality and morbidity impacting on self-care of 15%. In those without deep perforating arterial supply the morbidity was 10% and with deep perforating arterial supply or deep meningeal recruitment there was a combined morbidity and mortality of 44%. This difference in outcome was statistically significant (P