Comparative surgical outcome associated with the management of brain arteriovenous malformation in a regional neurosurgical centre
| Autor: | Adam M. H. Young, Mario Teo, Edward J St George |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Intracranial Arteriovenous Malformations Male medicine.medical_specialty Microsurgery Adolescent medicine.medical_treatment Radiosurgery Neurosurgical Procedures Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Seizures medicine Humans 030212 general & internal medicine Child Watchful Waiting Aged Retrospective Studies business.industry Endovascular Procedures Retrospective cohort study Arteriovenous malformation General Medicine Middle Aged medicine.disease Combined Modality Therapy Surgery Treatment Outcome Child Preschool Cohort Anticonvulsants Female Neurology (clinical) business Intracranial Hemorrhages 030217 neurology & neurosurgery Watchful waiting Cohort study Follow-Up Studies |
| Zdroj: | British journal of neurosurgery. 30(6) |
| ISSN: | 1360-046X |
| Popis: | Microsurgical resection of brain arteriovenous malformation (AVMs) is challenging, however, expert surgical series from large volume centres, have reported over 95% occlusion rates with 2 to 8% risk of morbiditymortality. Data from a regional neurosurgical unit was analysed and compared with published series for the purposes of quality control. We also compared our surgical result with other treatment modalities from the whole AVM cohort managed over the same study period.Retrospective analysis of a locally held AVM database.Of the 141 AVM patients, 54 (35M, 19F, age range 9-68 years) underwent microsurgical removal of AVM by the senior author, from 2006 to 2012. 27 (19%), 18 (13%), 20 (14%), 22 (16%) had endovascular therapy only, radiosurgery only, combination therapy (endovascular and radiosurgery) and conservative management, respectively.Case notes were reviewed to determine clinical and radiological outcomes. Statistical analysis performed using SPSS with p 0.05 defined as statistical significance.In the surgical series, the Spetzler-Martin (SM) grade distribution was as follows: 17 grade I (32%), 31 grade II (57%), and 6 grade III (11%). 31 patients (57%) presented with intracranial haemorrhage, 12 patients (22%) with seizures. Of the 54 patients, 51 (94%) had angiographically confirmed obliteration of their AVM. Median follow-up for the entire cohort was 7 years. 83% of surgical patients have mRS 0-1, compared to 78%, 67%, 45%, 18% of patients managed by endovascular therapy, radiosurgery, combination therapy, conservative surveillance, respectively (p 0.0001). However, the groups were not comparable in terms of SM grade or clinical presentation and the numbers in each group were relatively small. Seizure presentations were encountered in 23% (32/141) of the overall patients, and all the surviving patients were on anticonvulsants, except in the surgical arm, 7/12 (58%) patients were off their antiepileptic medications at last follow-up.The results demonstrate a 94% surgical obliteration rate and 11% long-term neurological deficits for brain AVM patients managed surgically and were comparable to expert series. Achieving acceptable results is possible in lower volume settings, however, patient selection is important and the role of an experienced neurovascular team cannot be overstated. |
| Databáze: | OpenAIRE |
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