title: Impact on seizure control of surgical resection or radiosurgery for cerebral arteriovenous malformations.
abstract: BACKGROUND
  Seizures are a common presenting symptom of arteriovenous malformations (AVMs). However, the impact of treatment modality on seizure control remains unclear.
  
  
  OBJECTIVE
  To compare seizure control after surgical resection or radiosurgery for AVMs.
  
  
  METHODS
  We analyzed retrospectively collected information for 378 patients with cerebral AVMs treated at our institution from 1990 to 2010. The application of strict inclusion criteria resulted in a study population of 164 patients.
  
  
  RESULTS
  In our cohort, 31 patients (20.7%) had Spetzler-Martin grade I AVMs, 51 (34.0%) grade II, 47 (31.3%) grade III, 20 (13.3%) grade IV, and 1 (0.7%) grade V. Of the 49 patients (30%) presenting with seizures, 60.4% experienced seizure persistence after treatment. For these patients, radiosurgery was associated with seizure recurrence (odds ratio: 4.32, 95% confidence interval: 1.24-15.02, P = .021). AVM obliteration was predictive of seizure freedom at last follow-up (P = .002). In contrast, for patients presenting without seizures, 18.4% experienced de novo seizures after treatment, for which surgical resection was identified as an independent risk factor (hazard ratio: 8.65, 95% confidence interval: 3.05-24.5, P < .001).
  
  
  CONCLUSIONS
  Although our data suggest that achieving seizure freedom should not be the primary goal of AVM treatment, surgical resection may result in improved seizure control compared with radiosurgery for patients who present with seizures. Conversely, in patients without presenting seizures, surgical resection increases the risk of new-onset seizures compared with radiosurgery, but primarily within the early posttreatment period. Surgical resection and radiosurgery result in divergent seizure control rates depending on seizure presentation.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joanna Y
authors.initials: JY
authors.lastname: Wang
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.forename: Xiaobu
authors.initials: X
authors.lastname: Ye
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Coon
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult