Open AccessMicrosurgery for intracranial arteriovenous malformation: Long-term outcomes in 445 patients
Author(s) -
Qingqing Ren,
Min He,
Yan Zeng,
Yong Li,
Hao Líu,
Jianguo Xu
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0174325
Subject(s) - medicine , modified rankin scale , grading scale , microsurgery , arteriovenous malformation , surgery , intracranial arteriovenous malformations , grading (engineering) , retrospective cohort study , radiosurgery , intracerebral hemorrhage , cerebral angiography , angiography , subarachnoid hemorrhage , ischemic stroke , radiation therapy , civil engineering , ischemia , engineering
Background The management of intracranial arteriovenous malformations(AVMs) poses challenges to the cerebrovascular specialists. Objective To review the long-term outcomes of intracranial AVMs treated with microsurgical resections. Methods We performed a retrospective review of 445 patients with intracranial AVMs treated in our hospital from January 1 st , 2008 to December 31 st , 2014. The extracted data included demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, Supplemented Spetzler-Martin (SM-Supp) Grades, treatment modalities, long-term outcomes, and obliteration rates. Outcome was assessed with a post-operative modified Rankin Scale (mRS) score at the last follow-up visit. Results Of the 445 patients treated with microsurgery, 298 (67.0%) patients initially presented with hemorrhage. Based on the SM grading system, the patients were graded as follows: 83(18.6%) Grade I, 156(35.1%) Grade II, 132(29.7%) Grade III, 61(13.7%) Grade IV and 13(2.9%) Grade V. Overall, 344(77.3%) patients had a favorable outcome (mRS score of 0–2). The favorable outcome for Grade I and II were 92.8% and 85.9%, respectively, sharply reducing to 52.5% in patients with Grade IV and 15.4% in patients with Grade V AVMs. 388(87.2%) patients achieved complete obliteration of the AVMs. 63(14.2%) patients experienced recurrent hemorrhage, and the frequency of rehemorrhage was highest in Grade V patients (77.0%), dropping to 3.6% and 3.8% in patients with Grade I and II lesions, respectively. Permanent neurological deficits occurred in 66(14.8%) patients and death in 35(7.9%) patients. There was no difference of AUROC values between SM grading system and SM-supp grading system (0.726 and 0.734, respectively, p = .715). Conclusion The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Microsurgical resection for AVMs depends on the SM grades, and the morbidity-mortality rate increases with an increasing SM grade.