Long-term outcome after surgical excision of parenchymal arteriovenous malformations in patients over 60 years of age.
BACKGROUND
Age is considered an important limiting factor for surgical excision of parenchymal arteriovenous malformations (AVMs) and a more conservative therapeutic approach has been advocated in the elderly. There are no studies available investigating the long-term outcome after surgical excision of parenchymal AVMs in patients over 60 years of age.


METHODS
We report the surgical outcome after excision of an AVM in a series of 13 consecutive patients older than 60 years. Medical records were analyzed retrospectively.


RESULTS
Hemorrhage was the mode of presentation in all patients. Three patients were admitted in a comatose state. Surgery was performed within 1 week from the initial bleeding in seven cases and within 2 weeks in five cases. There were no deaths directly related to surgery in this series. However, one patient died as a result of an intracranial hemorrhage complicating preoperative embolization and another patient died 3 months after surgery from intervening medical complications. During the follow-up period (mean 46 months), three more patients had died 8, 19, and 48 months after surgery, respectively. Of the remaining eight patients, six are doing well and are independent in the activities of daily living. One patient is independent but requires supervision, and the remaining one was lost to follow-up.


CONCLUSIONS
Age alone should no longer be considered a contraindication to treatment. In selected cases, surgery can be performed safely even in the elderly patient with an AVM. After surgical excision, elderly patients have the potential for several years of active life.
Lanzino
G
G
Department of Neurosurgery, Virginia Neurological Institute, University of Virginia, Charlottesville, USA.
Fergus
A H
AH
Jensen
M E
ME
Kongable
G L
GL
Kassell
N F
NF
D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome