[Postoperative morbidity and mortality after microsurgical exclusion of cerebral arteriovenous malformations. Current data and analysis of recent literature].
OBJECTIVE
Microsurgical exclusion of a cerebral arteriovenous malformation (AVM) can compare favorably with radiosurgery. We sought to assess its rate of morbidity-mortality as it is presently reported in the literature, and to discuss some of its current and worthwhile indications.


METHODS
Through Medline and additional searches by hand, we retrieved studies reporting the clinical and angiographic results after microsurgical excision of an AVM published between january 1990 and december 2000.


RESULTS
a) Postoperative mortality was 3.3% (68/2 452 patients from 25 studies). Permanent postoperative morbidity was 8.6%. Morbidity was never absent varying from 1.5% to 18,7%. The morbidity-mortality rate increased with an increasing Spetzler-Martin's grade, and was related to the location of the AVM. A 4.6% morbidity (from 1.5% to 9.7%) and a zero mortality were reported after microsurgical removal of small lesions of less than 3 cm in diameter. b) Postoperative angiography confirmed a total excision of the AVM in 97% of the cases (1 050/1 076 patients over 11 series), varying from 91% to 100%. c) Permanent morbidity related to pre-surgical embolization varied from 4% to 8.9%. Results from multiple or combined treatment including microsurgery could not be summed up.


CONCLUSIONS
A complete and definitive microsurgical excision of an AVM can be achieved with a high success rate and a low morbidity-mortality rate, according to sound indications and to the neurosurgeon's personal experience. The choice for a best treatment of an AVM is no longer limited to microsurgery; it is a team decision where the neurosurgeon plays a determining role.
Castel
J P
JP
Clinique Universitaire de Neurochirurgie, Hôpital Pellegrin, 33076 Bordeaux Cedex.
Kantor
G
G
D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology*; D019090:Case Management; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D005602:France / Q000453:epidemiology; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000191:economics / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome