Ruptured cerebral arteriovenous malformations: Outcomes analysis after microsurgery.
OBJECTIVE
Our study aimed to evaluate the functional outcome and the risk of postoperative remnant in patients with rAVM after microsurgical treatment.


METHODS
This is a retrospective of 139 consecutive patients operated for a rAVM between 2002 and 2012 in our institution. The age at diagnosis and the WFNS score were recorded for each patient before treatment. All patients were re-evaluated 3 months after treatment using mRS scale. Conventional angiography was performed in the first 2 postoperative weeks and then a year later to detect any remnant or recurrence.


RESULTS
The mean age at diagnosis was 30.8 years (range 4-69 SD: ±5) and 44 patients had an age at diagnosis <18 yo. The mRS score 3 months after treatment was ≤2 in 104 patients (83%). Predictive factors of good functional outcome were age at diagnosis <25 yo, initial WFNS score ≤ 2, SPM grade ≤ 2 and absence of acute hydrocephalus (p<0.05). Complete obliteration was obtained in 123 patients (89.5%) after the first microsurgical treatment. Early postoperative conventional angiography revealed a rAVM remnant in 16 patients (10.5%). Late conventional angiography showed a recurrence in 6 patients (4.5%). All of them were <18 yo. Predictive factors of postoperative rAVM remnant were an initial WFNS score>2, SPM grade>2 and preoperative evaluation limited only to CT angiography in emergency situation (p<0.05).


CONCLUSIONS
Functional outcome after microsurgical treatment was good in 83% of patients with rAVM. Good results were also recorded in 28% of patients with poor initial neurological status and severe intracerebral hemorrhage, which required immediate surgery. In case of remnant, a further treatment should be decided in a true multidisciplinary discussion to protect the patient from any rebleeding.
Department of Neurosurgery, Lille University Hospital, France. Electronic address: rabihdoc@hotmail.com.
Rabih
R
Aboukaïs
Department of Neurosurgery, Lille University Hospital, France.
Paulo
P
Marinho
Department of Neurosurgery, Lille University Hospital, France.
Marc
M
Baroncini
Department of Neurosurgery, Lille University Hospital, France.
Philippe
P
Bourgeois
Department of Neuroradiology, Lille University Hospital, France.
Xavier
X
Leclerc
Department of Neurosurgery, Lille University Hospital, France.
Matthieu
M
Vinchon
Department of Neurosurgery, Lille University Hospital, France.
Jean-Paul
JP
Lejeune
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D002532:Intracranial Aneurysm / Q000601:surgery*; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016634:Radiosurgery; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D020521:Stroke / Q000601:surgery; D055815:Young Adult
AVM; Aneurysm; Nidus; Outcome; Remnant