Determinants of neurological outcome after surgery for brain arteriovenous malformation.
OBJECTIVE
We sought to define determinants of neurological deficit after surgery for brain arteriovenous malformation (AVM).


METHODS
One hundred twenty-four prospective patients (48% women, mean age 33 years) underwent microsurgical brain AVM resection. Patients were examined by 3 study neurologists immediately before surgery, postoperatively in-hospital, by in-person long-term follow-up, and with a structured telephone follow-up. They were classified according to the 5-point Spetzler-Martin grading system, with its 3 elements: size, venous drainage pattern, and location. The functional neurological status was classified with the modified Rankin scale. Multivariate logistic regression models were applied to test the effect of patient age, gender, and the 3 Spetzler-Martin elements on early and long-term postoperative neurological complications.


RESULTS
Twelve patients (10%) were classified as Spetzler-Martin grade 1; 36 (29%) as grade 2; 47 (38%) as grade 3; 26 (21%) as grade 4; and 3 (2%) as grade 5. Postoperatively, in-hospital, 51 patients (41%) showed new neurological deficits (15% disabling [ie, Rankin scale score >2] and 26% nondisabling [ie, Rankin 1 or 2]). At long-term follow-up (mean follow-up time 12 months), 47 patients (38%) revealed surgery-related neurological deficits (6% disabling; 32% nondisabling). The rate of neurological complications increased by Spetzler-Martin grade. Female gender, AVM size, and deep venous drainage were significantly associated with neurological deficits at in-hospital and long-term evaluation. For patient age and AVM location, no significant association was found.


CONCLUSIONS
The findings suggest that female gender, AVM size, and AVM drainage into the deep venous system may be determinants of neurological deficit after microsurgical AVM resection.
Hartmann
A
A
New York Presbyterian Hospital, New York, NY, USA. ahart@zedat.fu-berlin.de
Stapf
C
C
Hofmeister
C
C
Mohr
J P
JP
Sciacca
R R
RR
Stein
B M
BM
Faulstich
A
A
Mast
H
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001921:Brain / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome