Ruptured cerebral arteriovenous malformations: Outcomes analysis after microsurgery

• Ruptured cerebral arteriovenous malformations are often managed by neurosurgeons.
• Good functional outcome after microsurgery was noted in 83% of patients.
• Complete obliteration after microsurgery was obtained in 89.5% of patients.
• Postoperative angiography is necessary, to detect any remnant or recurrence.
• Microsurgical treatment is more effective in case of low grade SPM AVM.

ObjectiveOur study aimed to evaluate the functional outcome and the risk of postoperative remnant in patients with rAVM after microsurgical treatment.Materials and methodsThis 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.ResultsThe 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).ConclusionFunctional 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.