[Immediate outcomes of microsurgical treatment of cerebral arteriovenous malformations in non-hemorrhagic patients].

Autor:	Gorozhanin VA; Burdenko Neurosurgical Institute, Moscow, Russia., Eliava SS; Burdenko Neurosurgical Institute, Moscow, Russia., Pilipenko YV; Burdenko Neurosurgical Institute, Moscow, Russia., Shekhtman OD; Burdenko Neurosurgical Institute, Moscow, Russia., Sazonova OB; Burdenko Neurosurgical Institute, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko [Zh Vopr Neirokhir Im N N Burdenko] 2018; Vol. 82 (6), pp. 30-37.
DOI:	10.17116/neiro20188206130
Abstrakt:	Arteriovenous malformations (AVMs) are some of the most frequent congenital abnormalities of the cerebral vascular system and usually occur at a young age. Given the fact that AVMs can manifest, in addition to hemorrhages, as symptomatic epilepsy (17-40%) that occurs more often at a young age and may lead to significant disability, investigation of this pathology remains topical. Particular attention has recently been paid to the management of AVM patients without clinical signs of hemorrhage at the time of pathology diagnosis. Objective: The objective of this study was to optimize the management of patients with unruptured AVMs based on analysis of the immediate outcomes of microsurgical treatment. Material and Methods: We retrospectively analyzed the immediate outcomes of microsurgical treatment of AVM patients hospitalized to the Burdenko Neurosurgical Institute in the period from 2009 to 2017. The patients included in the study met the following criteria: age over 18 years; microsurgical resection of AVM. The main exclusion criterion was a hemorrhage history confirmed by clinical data or verified by a neuroimaging study (MRI/CT). The study included 160 patients (58.1% males and 41.9% females) aged 18 to 67 years (mean, 33.5 years). According to the clinical course, patients with epileptic syndrome prevailed: 99 (61.9%) cases. Headaches occurred in 49 (30.6%) patients; 8 (5%) patients had asymptomatic AVMs; 4 (2.5%) patients had ischemic stroke. The surgical risk was assessed by using the Spetzler-Martin (S-M) scale: Grade I - 18 (11.3%) patients, Grade II - 71 (44.4%) patients, Grade III - 60 (37.5%) patients, and Grade IV - 11 (6.8%) patients. Direct surgery in patients with AVMs classified as S-M V was not planned. Results: Postoperative analysis revealed that 33 patients included in the study group in accordance with the above criteria had silent AVM hemorrhage that was confirmed only based on the intraoperative picture. The best surgical treatment outcomes were observed in patients with S-M I and II AVMs. The outcome scored 4 and 5 on the Glasgow Outcome Scale (GOS) was in 100% of cases in the S-M I group, 98.6% in the S-M II group, 86.7% in the S-M III group, and 81.8% in the S-M IV group. The relatively good outcomes of S-M IV AVM resection are explained by careful selection of patients for surgery. In general, good postoperative outcomes (GOS score of 4 and 5) were in 93.2% of patients. The main newly developed postoperative symptoms were visual impairments - visual field defects (64.7% of all complications). Postoperative mortality was 1.3%. Conclusion: Surgical treatment is indicated for patients with unruptured AVMs and S-M I or II surgical risk, regardless of clinical manifestations. In other cases, the treatment approach depends on a number of risk factors.
Databáze:	MEDLINE
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