J Korean Neurosurg Soc.  2024 Sep;67(5):541-549. 10.3340/jkns.2024.0095.

Surgical Results with Low-Grade Arteriovenous Malformations : A Single Center 14-Year Experience

• Hong WJ
• Ahn KH
• Lee Yj
• Kim WB
• Kim YS
• Kim TS
• Joo SP

• KMID: 2558679
• DOI: http://doi.org/10.3340/jkns.2024.0095

Abstract

Objective
: Advancements in AVM surgical techniques for cerebral arteriovenous malformation (AVM) underscore its efficacy. Our research aims to showcase the positive outcomes of treating low-grade AVMs surgically, focusing on safety and effectiveness.
Methods
: We retrospectively reviewed 55 patients (36 males and 19 females; average age 37.4 years) with Spetzler-Martin (S-M) grade 1 and 2 AVMs who underwent surgical resection between January 2009 and December 2022.
Results
: In our study, 55 patients with S-M grade 1 and 2 AVMs underwent surgical resection, evenly divided between grades 1 (50.9%) and 2 (49.1%). Intracranial hemorrhage was the primary symptom in 74.5% of cases. Pre-operative Glasgow coma scale (GCS) scores revealed 69.1% of patients scored above 13, with 18% below 8. Successful resection was achieved in 87.3%. Postoperatively, 95.5% of ruptured and 90.9% of unruptured AVM patients showed lower or same modified Rankin scale scores. Poorer outcomes were significantly linked to lower GCS scores and intranidal/flow-related aneurysms through multivariate logistic regression. Postoperative seizures noted in nine patients, were exclusive to the ruptured AVM group.
Conclusion
: Our findings indicate surgical resection as a beneficial treatment for low-grade AVMs, yielding high cure rates and positive functional outcomes in both ruptured and unruptured cases. Preoperative GCS scores and the presence of associated aneurysms are predictive of postoperative functional status. Additionally, managing postoperative seizures effectively is key to enhancing prognosis.

Keyword

Arteriovenous malformations, intracranial; Surgery; Outcome

Figure

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  Fig. 1. Patient selection process flowchart. AVM : arteriovenous malformation, S-M : Spetzler-Martin.

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  Fig. 2. Surgical removal for ruptured arteriovenous malformation (AVM) case. A : Pre-operative computed tomography scan illustrating a right frontoparietal hematoma. B : Pre-operative digital subtraction angiogram (DSA) from the right internal carotid artery reveals the AVM as the source of hemorrhage, slated for surgical excision. C : Post-operative DSA confirming the AVM’s absence, indicative of successful surgical removal. D and E : Detailed surgical approach involving microsurgical removal of the AVM via navigated craniotomy and meticulous excision, including clipping of the feeding artery. F : The extracted surgical specimen, showcasing the completely resected AVM.

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  Fig. 3. Surgical removal for unruptured arteriovenous malformation (AVM) case. A : Pre-operative gadolinium-enhanced axial T1-weighted magnetic resonance image depicts an unruptured right frontal AVM. B : Pre-operative digital subtraction angiography (DSA) from the right internal carotid artery identifies the AVM, targeted for surgical removal. C : Post-operative DSA confirms the AVM’s absence, indicating successful surgical eradication. D and E : Description of the surgical technique involving microsurgical removal of the AVM via navigated craniotomy and precise excision, with clipping of the feeding artery. F : The surgical specimen, demonstrating the completely excised AVM.

Reference

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