Acute surgical removal of low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations.
BACKGROUND
Early surgical removal of cerebral AVMs is a relatively infrequent therapeutic option when dealing with a cerebral hemorrhage caused by AVM rupture: even in the case of low-grade AVMs, delayed treatment is, if possible, preferred because it is considered safer for patients and more comfortable for surgeons. To assess whether acute surgery may be a safe and effective management, we conducted a retrospective analysis of our early surgery strategy for ruptured low-grade AVMs.


METHODS
We reviewed 27 patients with SM grade I-II AVM treated during 2004 to 2008 in the acute stage of bleeding (within the first 6 days after bleed). All patients showed a cerebral AVM on DSA at admission, and surgical removal was controlled by postoperative angiography. Neurological outcomes were assessed with GOS. The average length of follow-up was 22 months (48-3 months).


RESULTS
Before surgery, 16 (59%) patients showed a GCS of 8 or less, 2 of them presenting an acute rebleeding after first hemorrhage. All patients underwent radical AVM surgical removal and hematoma evacuation in a single-stage procedure. Most patients (78%) were operated within the first day of hemorrhage. A favorable functional outcome (GOS: good recovery or moderate disability) was observed in 23 patients (85%). Mortality was 7.4%. Outcome was not significantly correlated with GCS at presentation and with presence of preoperative anisocoria.


CONCLUSIONS
Early surgery for grade I-II AVMs is a safe and definitive treatment, achieving both immediate cerebral decompression and patient protection against rebleeding, reducing time of hospital stay and allowing a more rapid rehabilitative course whenever necessary.
Pavesi
Giacomo
G
Neurosurgical Operative Unit, Padova Hospital, 35100 Padova, Italy. giacomo.pavesi@sanita.padova.it
Rustemi
Oriela
O
Berlucchi
Silvia
S
Frigo
Anna Chiara
AC
Gerunda
Valerio
V
Scienza
Renato
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002543:Cerebral Hemorrhage / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult