[Long-term outcome of operatively and non-operatively managed high-grade intracranial arteriovenous malformations and factors influencing postoperative neurological deficits].
OBJECTIVE
To compare the effects of surgical and non-surgical treatments for high-grade intracranial arteriovenous malformation (AVM), identify the determinants of neurological function deterioration after surgery, and calculate the annual hemorrhage rate.


METHODS
98 high-grade intracranial AVM patients underwent surgery, and 44 high-grade intracranial AVM patients underwent conservative treatment. Follow-up was conducted on 141 of these 142 patients for (54+/-36) (6-118) months. MRI and DSA were conducted before and/or after treatment on most of the patients. Glasgow outcome score (GOS) was used to evaluate the neurological functions early and more then 6 months after discharge. The clinical data of these 142 patients were retrospectively analyzed. The annual hemorrhage rate associated with these lesions was calculated.


RESULTS
The annual hemorrhage rate of these 142 patients was 2.1%. The integrated rate of late disability and mortality of the operative group was 10.1%, remarkably higher than that of the non-operative group (25.0%). AVM size, adjacent brain functional region, Spetzler-Martin grade, deep perforating arterial supply, and intra-operative bleeding volume were significantly correlated with early and permanent neurological function deficits.


CONCLUSIONS
The long-term outcome of operatively managed intracranial high-grade AVMs is superior to that of the non-operatively treated ones. Spetzler-Martin grade and deep arterial perforating supply are the most important determinants of neurological deficit after microsurgical resection of AVM.
Deng
Zheng-hai
ZH
Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China.
Wang
Shuo
S
Zhao
Yuan-li
YL
Zhang
Dong
D
Zhao
Ji-zong
JZ
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult